Invasive Klebsiella pneumoniae brain abscess due to endotipsitis: a case report

Endotipsitis is an unusual but severe complication of a transjugular intrahepatic portosystemic shunt (TIPS), and is described as clinically significant, with sustained sepsis and with or without vegetation or thrombus in the TIPS stent. We present a patient with endotipsitis after TIPS placement who developed a brain abscess due to persistent Klebsiella pneumoniae sepsis caused by endotipsitis, without any common risk factors. To our knowledge, this is the first case of brain abscess due to persistent Klebsiella pneumoniae sepsis caused by endotipsitis. This case demonstrates that recurrent endotipsitis may lead to serious complications in distant organs. Although liver transplantation with stent removal represents the most thorough means of source control in principle, prolonged remission can be achieved with antimicrobial therapy alone in some patients.