Infect Chemother.  2008 Dec;40(6):341-345. 10.3947/ic.2008.40.6.341.

A Case of Klebsiella pneumoniae Liver Abscess Which Progressed to Pyomyositis and Infected Aneurysm of Aorta

• Kim JH
• Kim JE
• Back SY
• Koo TY
• Lee KA
• Jung KH
• Kim HC
• Kim HY
• Pai H

• KMID: 1782303
• DOI: http://doi.org/10.3947/ic.2008.40.6.341

Abstract

Klebsiella pneumoniae causes pyogenic infections in various sites, with the risk of which increases in patients with diabetes mellitus. Recently, K. pneumoniae has emerged as a leading cause of pyogenic liver abscess. Primary liver abscess caused by K. pneumoniae in the absence of underlying hepatobiliary disease is commonly associated with metastatic infections such as endophthalmitis, meningitis, brain abscess and infection in other sites. We experienced a case of K. pneumoniae liver abscess associated with septic metastatic lesions including pyomyositis and infected aneurysm of aorta. Despite the aggressive management with antibiotics, surgical pus drainage and aortic bypass graft, patient died of ventilator associated pneumonia and multiorgan failure. Our experience suggests that clinicians should be alert to septic metastatic infections when they treat a patient with K. pneumoniae liver abscess.

Keyword

Klebsiella pneumoniae; Liver abscess; Pyomyositis; Aortic aneurysm; Diabetes mellitus

MeSH Terms

Aneurysm, Infected
Anti-Bacterial Agents
Aorta
Aortic Aneurysm
Brain Abscess
Diabetes Mellitus
Drainage
Endophthalmitis
Humans
Klebsiella
Klebsiella pneumoniae
Liver
Liver Abscess
Liver Abscess, Pyogenic
Meningitis
Pneumonia
Pneumonia, Ventilator-Associated
Pyomyositis
Suppuration
Transplants
Anti-Bacterial Agents

Figure

• 

  Figure 1 (A) Abdominal CT scan reveals about 3 cm sized lobulated liver abscess in segment 8. (B) Follow up abdominal CT scan after two months shows decreased size of liver abscess.

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  Figure 2 (A) Coronal STIR MR image of both calves on admission shows high signal intensity along the calf muscle, fascia, and subcutaneous tissue. (B) CT scan of lower extremities on the 9th hospital day shows extensive fluid collections with peripheral enhancement within the muscle of both lower legs. (C) Follow up CT scan on the 23th hospital day shows regression of the abscess.

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  Figure 3 Abdominal CT scan on the 32th hospital day shows a well localized hematoma involving the distal esophagus (arrow) (A) which extends across the gastroesophageal junction into the body of the stomach (arrow) (B). High-attenuation fluid in perigastric, perisplenic and perihepatic area is noted and suggests hemoperitoneum (C).

• 

  Figure 4 Chest CT scan shows proximal descending aortic aneurysm measuring 9 cm in diameter with diffuse hematoma in paraesophageal area.

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