A case report of septic metastatic meningitis from Klebsiella pneumoniae liver abscess after hepaticojejunostomy for bile duct cancer

Abstract

A 63-year-old female who underwent bile duct resection with hepaticojejunostomy for bile duct cancer on August 2004 was admitted on November 2004 because of a liver abscess due to the postoperative reflux cholangitis. We performed the percutaneous transhepatic abscess drainage, and the Klebsiella pneumoniae was identified from the cultures of both arterial blood and the purulent discharge from the liver abscess. She had consciousness disturbance and neck stiffness three days after admission. The septic metastatic bacterial meningitis due to K. pneumoniae liver abscess was confirmed with the increasing of cell count of the cerebrospinal fluid (CSF) and the detection of K. pneumoniae from CFS. Although both liver abscess and meningitis were improved by the percutaneous drainage and the administration of the antibiotics for eight weeks, the normal pressure hydrocephalus that was a sequela of the meningitis was occurred and the ventriculoperitoneal shunt was necessary to relieve the symptoms.