Introduction: Invasive Klebsiella Pneumoniae Liver Abscess Syndrome (IKPLAS) consists of liver abscess findings on imaging with blood cultures or aspirate positive for Klebsiella Pneumoniae, in the absence of hepatobiliary disease. This entity is ominous from other pyogenic liver abscesses in that it can lead to metastatic infections, such as endophthalmitis, meningitis, and brain abscesses.
Case Presentation: A 34-year-old south Asian male presented with sudden onset of severe, non-radiating right upper quadrant (RUQ) abdominal pain associated with nausea, vomiting and fever. Pertinent history included recent treatment for a dental abscess. On physical exam patient was found to be febrile, tachycardic and tachypneic. Other significant findings included RUQ tenderness. Laboratory data revealed a white blood cell count of 13,700/mm³ and lipase of 31,262 U/L. RUQ ultrasound did not show any biliary obstruction, dilatation or gallbladder disease. The patient was conservatively managed for acute pancreatitis. The following day, blood cultures returned positive for gram-negative bacilli. Although appropriate antibiotics were started, he continued to spike fevers. Computed tomography abdomen was performed showing multiple cystic lesions in the right upper lobe of the liver and no pancreatic pathology. At this time, final cultures grew Klebsiella Pneumoniae. Magnetic Resonance Cholangiopancreatography was performed showing multiple lobulated cystic masses suggestive of liver abscesses. IKPLAS was diagnosed. Once blood cultures remained sterile, he was sent home on four weeks of ceftriaxone with outpatient needle aspiration planned.
Discussion: IKPLAS is increasingly being reported in Asia and is now emerging as a global disease. In the case series of Lederman in 2005 and Pastagi in 2008 up to 38 patients were diagnosed with Klebsiella Pneumoniae liver abscess in the United States. Klebsiella Pneumoniae can spread hematogenously, or via the portal or biliary system. Important risk factors for IKPLAS are diabetes mellitus, fatty liver disease, and recent antibiotic use. Clinical features include right upper quadrant abdominal pain, fever, nausea and vomiting. When Klebsiella Pneumoniae is isolated from the abscess or blood culture of a patient with imaging consistent with liver abscess, the diagnosis can be made. Treatment includes four to six weeks of parenteral antibiotics and either needle aspiration or percutaneous drainage of the lesion.
Conclusions: A high suspicion for IKPLAS should be held in Asian patients with gram-negative bacilli bacteremia and RUQ abdominal pain. This should push clinicians to look for intra-abdominal pathologies, such as liver abscesses. Awareness of IKPLAS entity and potential metastatic complications can speed recovery time and decrease overall morbidity.
To cite this abstract:Rizvi N, Fatima U, Rajput F, Jaffari F. A Case of Invasive Klebsiella Pneumoniae Liver Abscess Syndrome. Abstract published at Hospital Medicine 2015, March 29-April 1, National Harbor, Md. Abstract 668. Journal of Hospital Medicine. 2015; 10 (suppl 2). https://www.shmabstracts.com/abstract/a-case-of-invasive-klebsiella-pneumoniae-liver-abscess-syndrome/. Accessed April 7, 2020.