P2900 - Pyogenic Liver Abscess Presenting as Obstructive Jaundice From Klebsiella Pneumoniae in Texas

Kevin Brown, MD, Michelle Baliss, DO, Minh N. Tran, MD, Lindsay Sonstein, MD
University of Texas Medical Branch at Galveston, Galveston, TX

Introduction: A pyogenic liver abscess (PLA) is a suppurative infection involving the hepatic parenchyma and account for roughly 80% of all liver abscesses. Traditionally, PLA was associated with intra-abdominal infections or leakage of intrabdominal bowel contents and was polymicrobial. One organism of interest is Klebsiella pneumoniae, which is the leading cause of PLA in several parts of Asia, making up 50-85% of cases. PLA with K. pneumoniae is becoming more common globally, especially here in the Unites States. PLA from K. pneumoniae often occurs in the absence of intraabdominal or hepatobiliary disease and has been associated with diabetes mellitus and underlying colorectal cancer. Early recognition and treatment of PLA is crucial to prevent development of bacteremia. PLA at presentation often includes fever (seen in 90% of cases), abdominal pain (50-75%), and elevated alk phos (60-90%), while jaundice and compression of the biliary tree (12-27%) is rarer.

Case Description/Methods: A 59-year old man visiting from the Philippines with a medical history of HTN and type 2 DM presenting with five days of worsening fatigue, nausea, non-bloody vomiting, and scleral icterus was found to be in septic shock. He had developed the symptoms while in Mexico. Physical exam was notable for jaundice and hepatomegaly with a moderately distended abdomen. Presenting labs showed an elevated lactate, hyperbilirubinemia (total bilirubin 11.4, conjugated bilirubin 7.1), and increased alk phos. CT abdomen/pelvis showed a large, 12.9 cm hypo-attenuating cystic liver mass with ill-defined septations and peripheral enhancement. Blood cultures grew Klebsiella pneumonia. Patient underwent two percutaneous drain placement procedures, both of which incompletely drained the fluid. Roughly two weeks after presentation, while still in the hospital, he underwent exploratory laparotomy and successful drainage of hepatic abscess. He was monitored a few days afterwards with down trending labs before being discharged home.

Discussion: Here we presented a case of septic shock and obstructive jaundice secondary to a pyogenic liver abscess with Klebsiella pneumoniae. The patient had multiple risk factors for this disease such as diabetes and being from Southeast Asia. The treatment was complicated by multiple percutaneous and surgical interventions before being stable for discharge. Being aware of K. pneumoniae causing PLA should be included on a differential for obstructive jaundice is necessary.


Disclosures:


Kevin Brown, MD, Michelle Baliss, DO, Minh N. Tran, MD, Lindsay Sonstein, MD. P2900 - Pyogenic Liver Abscess Presenting as Obstructive Jaundice From Klebsiella Pneumoniae in Texas, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.