Abstract Introduction Klebsiella Pneumoniae invasive syndrome (KPIS) is a rare, disseminated infection that often presents as liver/prostatic abscesses with seeding to numerous organ systems. Due to its aggressive, unusual presentation, diagnosis is often missed or delayed. Case Presentation Patient 1: 29-year-old male with uncontrolled diabetes presented with abdominal pain and admitted for DKA. Abdominal MRI demonstrated a lesion suggestive of a hepatic necrotizing neoplasm vs. abscess. Subsequent imaging obtained to localize other infectious foci demonstrated abscess growth to 15cm and numerous pulmonary nodules. He underwent US hepatic drain placement and 9 weeks of ceftriaxone/flagyl with transition to 1 week PO bactrim given persistent abscess on imaging. Patient 2: 37-year-old male with B-thalassemia presented with jaundice, RUQ pain, and fever. Abdominal CT4P demonstrated a 9cm heterogenous septated hepatic mass. Ceftriaxone/flagyl was administered for 5 days and drainage was deferred due to improvement with medical management. Antibiotics were transitioned to ciprofloxacin/flagyl for 4 weeks, with an additional 4-week course of Augmentin due to repeat admission for fevers. Repeat imaging showed resolution of hepatic mass. Patient 3: 50-year-old male presented with abdominal pain and admitted to ICU for septic shock. CTPA/CTAP demonstrated numerous pulmonary cavitations, left internal illiac vein thrombus, and prostatic abscess, concerning for septic emboli. He also developed bilious vomiting and hyperbilirubinemia, but had an unremarkable MRCP and TTE. He was started on ceftriaxone/vancomycin and transitioned to 6 weeks of PO ciprofloxacin with pending repeat imaging. Patient 4: 53-year-old male presented with RUQ pain radiating to the back. CT imaging showed an 11cm hepatic and intercostal abscess, pulmonary cavitations, and right pleural effusion. He underwent abscess and pleural drainage and started on ceftriaxone/flagyl. Antibiotics were transitioned to ciprofloxacin upon discharge. He was re-admitted due to worsening vision and hepatic drain dislodgement, requiring drain replacement. Serial ophthalmology evaluations were negative for endophthalmitis. The patient was discharged with 12 weeks of ciprofloxacin and a follow-up US showed resolution of abscess. All cases had blood, pleural, and abscess cultures that grew klebsiella. No patients had elevated cancer-markers, international travel, or evidence of underlying chronic infection. Discussion This case-cluster within Southern California in a 4-month period amongst a Hispanic demographic typically not associated with KPIS demonstrates its prevalence in this region. KPIS has been well-described in Asian populations (particularly Taiwan), but 50 cases within the US. Further suspicion in a broader population should be considered for similar presentations prompting quick evaluation and treatment for widespread infection. This abstract is funded by: None
Long et al. (Fri,) studied this question.