Klebsiella pneumoniae Liver Abscess, Endophthalmitis, and Meningitis in a Man with Newly Recognized Diabetes Mellitus

In the United States, culture of material from pyogenic liver abscesses most often yields polymicrobial bowel flora [1]. In Taiwan, however, monomicrobial Klebsiella pneumoniae infection causes most pyogenic liver abscesses, particularly among diabetics [2]. Endogenous (hematogenous) endophthalmitis is a recognized complication in this population [3–5]. To my knowledge, this is the first report from the United States to describe a patient with K. pneumoniae liver abscess, endophthalmitis, and meningitis. A 38-year-old black man with no known medical problems was well until 4 days before admission, when he developed a headache and fever. Photophobia, neck stiffness, anorexia, and abdominal pain followed. On examination, the patient appeared uncomfortable, and his temperature was 40°C. Ophthalmologic examination findings were normal. Nuchal rigidity and right-upper-quadrant tenderness were present. Lumbar puncture yielded cloudy CSF with the following characteristics: WBC count, 372×106/L, with a predominance of polymorphonuclear leukocytes; total protein, 2.78 g/L; and glucose, 7.8 mmol/L (140 mg/dL). Gram staining revealed large, encapsulated gram-negative bacilli. The serum glucose concentration was 18.7 mmol/L (337 mg/dL). Hepatic aminotrans-ferase and γ-glutamyltransferase levels were each elevated to ∼5 times the upper limit of normal.