Arpine Petrosyan, MD, Jennifer Yoon, MD, Kamal Khorfan, MD, Marina Roytman, MD UCSF Fresno, Fresno, CA
Introduction: Klebsiella pneumoniae invasive syndrome(KPIS) is a rare infectious disease involving a primary liver abscess with metastatic infection and is rarely reported in North America. We present two cases of KPIS with a liver abscess and concomitant bacteremia occurring in California.
Case Description/Methods: Case 1 A 46 year old male with history of beta thalassemia and splenectomy presented with two days of abdominal pain and fever. He was febrile to 39.5ºC, heart rate 111, and blood pressure 90/60. Labs demonstrated WBC of 32.3 x 103 uL, bilirubin 5.9mg/dL, ALT of 27 U/L, AST of 30 U/L. Computerized tomography showed a cystic mass in the liver measuring 2x2.7x2.6cm. Patient was admitted to the intensive care unit with septic shock and treated with IV antibiotics. He underwent CT guided drainage of the abscess. Both drainage and blood cultures grew pan-sensitive klebsiella pneumoniae. He improved clinically and was discharged on a four week regimen of oral antibiotics. He was seen two weeks later with no abdominal pain and imaging showing improved hepatic abscesses. Case 2 A 47 year old male presented with three days of abdominal pain. Vitals were within normal limits apart from sinus tachycardia. Labs notable for WBC 13.9 x 103uL, ALP 194 U/L, total bilirubin 1 mg/dL, ALT 91 U/L, AST 51 U/L. CT of the abdomen showed a 3x4.3x5.1cm area of decreased attenuation within the hepatic parenchyma, suspicious on initial read for fatty infiltration. He was treated with IV antibiotics but required ICU transfer for septic shock and delirium tremens. Blood cultures grew pan-sensitive Klebsiella pneumoniae. A repeat CT on hospital day 7 showed a 15 x 9.6 cm multi-septated hypodense lesion in the right hepatic lobe. CT- guided drainage was done with cultures growing Klebsiella pneumoniae. He improved clinically and was discharged home with two weeks of antibiotics. Imaging one month following discharge showed significantly near complete resolution of the abscess.
Discussion: KPIS is rare condition involving formation of a liver abscess with associated metastatic findings such as bacteremia and meningitis (1). The condition, when present, is normally witnessed in Southeast Asia and rarely reported in North America (2). Our two cases highlight the difficulty in diagnosing and treating this condition, often requiring prolonged antibiotics. It is important to have a high index of suspicion to direct appropriate diagnostic work up, typically imaging and drainage if indicated, in order to appropriately guide management.
Figure: Figure 1. Case 1. Initial CT of the abdomen with IV contrast demonstrating the ill-defined cystic mass in the right lobe of the liver measuring 2x2.7x2.6cm (left). Repeat CT following two weeks after discharge showing decrease in size of liver abscess(Right)
Figure 2. Case 2. Initial CT on admission showing area of decreased attenuation within the hepatic parenchyma measuring 3x4.3x5.1cm, stated to be possible fatty infiltration. Figure 3. Case 2. Repeat CT showing 15 x 9.6 cm multi-septated hypodense lesion in the right hepatic lobe (same image in coronal and axial views)
Disclosures:
Arpine Petrosyan indicated no relevant financial relationships.
Jennifer Yoon indicated no relevant financial relationships.
Kamal Khorfan indicated no relevant financial relationships.
Marina Roytman indicated no relevant financial relationships.
Arpine Petrosyan, MD, Jennifer Yoon, MD, Kamal Khorfan, MD, Marina Roytman, MD. C0561 - Klebsiella Pneumoniae Invasive Syndrome: Two Cases Occurring in Northern America, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
