Multiple metastatic infections due to hypervirulent Klebsiella pneumoniae

Hypervirulent Klebsiella pneumoniae (hvKp) was first identified in Taiwan in 1986, and has emerged as a leading cause of severe community-acquired infections, particularly in Asia. Its metastatic nature, often involving the liver and eyes, poses significant diagnostic challenges and is associated with substantial morbidity.

A 47-year-old Taiwanese man with poorly controlled diabetes presented with fever, nausea, and blurred vision due to diabetic ketoacidosis, K. pneumoniae bacteremia, and endogenous endophthalmitis. Computed tomography revealed abscesses in the liver, lungs, kidney, and prostate. The isolate was confirmed as a hypervirulent strain (positive string test, K2 serotype, and virulence genes). Despite parenteral ceftriaxone and liver drainage, fever persisted. Gallium-67 scintigraphy localized concentrated inflammatory activity to the prostatic abscesses. This finding guided a definitive transrectal aspiration for source control. The patient completed eight weeks of antimicrobial therapy, transitioned from ceftriaxone to oral ciprofloxacin. Despite prompt systemic and intravitreal antibiotics, the right eye progressed to phthisis bulbi with total loss of light perception. At the 11-month follow-up, the patient remained systemically stable with no recurrence of infection.

Metastatic infections associated with hvKp frequently extend beyond the classic presentation of liver abscesses and endophthalmitis. Nuclear imaging, specifically Gallium-67 scintigraphy, can be instrumental in detecting occult inflammatory foci that may remain clinically silent. Maintaining high clinical vigilance regarding the diverse and often asymptomatic manifestations of hvKp, such as prostatic abscesses, is vital. Timely diagnostic intervention and aggressive source control are essential to prevent persistent sepsis and improve overall clinical outcomes.