Pulmonary Abscess, Endophthalmitis, and Lumbar Spine Infection Attributable to Invasive Klebsiella pneumoniae Liver...

Invasive Klebsiella pneumoniae Liver Abscess Syndrome (IKLAS) represents a serious multisite infection primarily triggered by a hypervirulent strain of Klebsiella pneumoniae. Among Asian patients with diabetes, these bacteria are relatively prevalent and have the potential to cause organ abscesses or sepsis. When patients present with multiple concurrent infections, their treatment becomes significantly more complex, necessitating a comprehensive diagnostic and therapeutic strategy. Instances of complex and severe infection cases are infrequently reported. Early detection of infections, selection of appropriate antibiotics, and proactive management of diabetes and related complications are critical determinants of patient prognosis.

A 52-year-old Chinese man with a history of type 2 diabetes mellitus arrived at the emergency department with fever and chills, and he was subsequently diagnosed with a pyogenic liver abscess accompanied by a pulmonary infection, exhibiting clinical signs of sepsis. The patient received intravenous administrations of vancomycin and piperacillin-tazobactam for anti-infection and subcutaneous insulin for managing hyperglycemia. Ultrasound imaging was employed to guide a percutaneous procedure for liver puncture and drainage. During treatment, he developed invasive Klebsiella pneumoniae liver abscess syndrome, complicated with osteomyelitis, lung abscesses, and endophthalmitis. He achieved complete recovery following a two-month treatment regimen that included ultrasound-guided percutaneous transhepatic drainage, vitrectomy, and anti-infective therapy.

This case suggests that clinicians should consider the possibility of invasive liver abscess syndrome caused by hypervirulent Klebsiella pneumoniae when treating diabetic patients who present with fever in the emergency setting. Targeted intravenous antibiotic therapy, glycemic control, and percutaneous abscess drainage play an essential role in managing invasive Klebsiella pneumoniae liver abscess syndrome.