Abstract Introduction Hypervirulent Klebsiella pneumoniae infections are associated with high morbidity and mortality due to their aggressive nature and proclivity for abscess formation. Herein we present a case of disseminated, hyper-virulent Klebsiella pneumoniae with involvement of the lung and liver. Case Description A 50-year-old male with type two diabetes mellitus presented with headache, nausea, and back pain. Review of systems was notable for dyspnea, poor appetite, weight loss, and chills. The patient had not used insulin in multiple weeks. Vital signs showed heart rate of 137 beats per minute with normal blood pressure and respiratory rate of 40 breaths per minute with peripheral oxygen saturation of 97% on ambient air. Physical exam demonstrated Kussmaul breathing, no abnormalities on auscultation, and non-tender abdomen. Labs were consistent with severe diabetic ketoacidosis (DKA). The patient initially improved with fluid resuscitation and intravenous insulin as part of a DKA protocol. However, approximately twelve hours after admission, he developed septic shock physiology requiring norepinephrine. Chest radiograph demonstrated left-sided peripheral consolidation as well as an abnormal air density below the right hemidiaphragm (Image A). Computed tomography of the chest and abdomen with intravenous contrast revealed multifocal pneumonia with a left upper lobe predominance (Image B) and a large right hepatic lobe subcapsular abscess measuring 6.5 by 6.2 by 5.8 centimeters (Image C). Blood cultures from admission grew Klebsiella pneumoniae. Interventional radiology placed a percutaneous intrahepatic abscess drain for source control. Abscess cultures grew Klebsiella pneumoniae. The patient was treated with ceftriaxone and metronidazole while inpatient and transitioned to amoxicillin-clavulanate on discharge to complete a minimum four-week course. Sinogram approximately three weeks after discharge showed significant decrease in size of the abscess. Discussion Klebsiella pneumoniae is an encapsulated, gram-negative bacterium found ubiquitously in the environment that commonly colonizes the gastrointestinal tract and nasopharynx. It is a highly adaptable, opportunistic pathogen with high degrees of virulence and multi-drug antibiotic resistance and often causes severe infections in immunocompromised hosts, especially those with alcohol use disorder or diabetes mellitus. Hypervirulent Klebsiella pneumoniae strains are identified by hyperviscosity and capsules that enhance immune evasion and tissue invasion, often leading to disseminated infection involving the lung, liver, eyes, and brain. This case demonstrates characteristic disseminated infection by community-acquired hypervirulent Klebsiella pneumoniae in a relatively immunosuppressed host. It is imperative to remain vigilant for infections that span multiple organ systems and consider hypervirulent Klebsiella pneumoniae in patients with lung and liver involvement. This abstract is funded by: None
Sprackling et al. (Fri,) studied this question.
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