Multiloculated Liver Abscess Due to Hypermucoviscous Klebsiella pneumoniae

Abstract

in 7%-12% of those cases. Mortality has ranged from 6% to 17%. The syndrome of hypermucoviscous community-acquired KLA is associated with higher rates of septic ocular or central nervous system complications, but not higher mortality [3]. The patient was transferred to the intensive care unit (ICU), and eventually intubated for progressive respiratory distress. Initial medical management consisted of meropenem, albenda-zole, and metronidazole. Blood cultures grew K. pneumoniae. A right-sided chest tube for pleural effusion that developed in the ICU was inadvertently placed in the liver abscess; cultures from this fluid also grew K. pneumoniae. The isolates were hypermucoviscous on blood agar, and were identified as capsular serotype K23 by capsular serotyping. Serology for Echinococcus, Entamoeba histolytica, hepatitis B and C, and human immuno-deficiency virus-1 and-2 were negative. Portal venous thrombosis was noted on a subsequent computed tomographic study. Despite effective antimicrobial administration and aggressive surgical debridement, progressive hepatic decompensation and enlargement of the abscess ensued; the patient was transferred to another center for evaluation of a liver transplant. Ultimately, following further open surgical drainage and antimicrobial treatment, the patient made an eventual recovery and was discharged home 3 months after admission to hospital.