Klebsiella pneumoniae-induced liver and prostate abscesses

A 72-year-old man with diabetes mellitus presented with a 2-day history of fever, lethargy, and shortness of breath. Upon admission, the patient was in a septic shock with severe respiratory distress, which required the administration of inotropic agents and mechanical ventilation. An urgent computed tomography (CT) scan of the abdomen and pelvis revealed a liver abscess in segment V and a prostate abscess (Figure 1). No physical examination findings indicated meningitis or endophthalmitis. He was administered an empirical antibiotic (intravenous piperacillin-tazobactam). Blood cultures revealed Klebsiella pneumoniae, which was susceptible to ampicillin-sulbactam. Consequently, we switched to ampicillin-sulbactam. However, the patient's clinical condition deteriorated, and he developed severe thrombocytopenia due to sepsis, which precluded surgical drainage. A 1-week follow-up scan revealed that the size of the liver and prostate abscesses had reduced slightly. Unfortunately, the patient passed away 3 weeks later because of a nosocomial infection.

FIGURE 1:
A CT scan of the abdomen and pelvis showing (a) a liver abscess in segment V measuring 3.9 x 3.6 x 2.9 cm and (b) a prostate abscess measuring 3.5 x 3.2 x 3.7 cm.

Compared with classic K. pneumoniae strains, hypervirulent strains of Klebsiella pneumoniae are more likely to cause severe disseminated infections such as community-acquired infections, including liver abscesses, pneumonia, meningitis, and endophthalmitis¹. Prostate abscess is a rare complication of K. pneumoniae infection; however, in Taiwan, K. pneumoniae is the most common pathogen associated with prostate abscess, especially in patients with diabetes². The optimal management of K. pneumoniae-induced liver and prostate abscesses includes confirming via imaging, administering appropriate antimicrobial therapy, and ensuring adequate drainage³.

ACKNOWLEDGEMENTS

None.

REFERENCES

• ¹ Chang CY, Ong ELC. Positive string test in hypervirulentKlebsiella pneumoniaeliver abscess. Oxf Med Case Reports. 2022;2022(4):omac035.
• ² Liu KH, Lee HC, Chuang YC, Tu CA, Chang K, Lee NY, et al. Prostatic abscess in southern Taiwan: another invasive infection caused predominantly by Klebsiella pneumoniae. J Microbiol Immunol Infect. 2003;36(1):31-6.
• ³ Jun JB.Klebsiella pneumoniaeLiver Abscess. Infect Chemother. 2018;50(3):210-18.

• Financial Support: None.

Publication Dates

• Publication in this collection
  24 July 2023
• Date of issue
  2023

History

• Received
  31 May 2023
• Accepted
  14 June 2023