Case Presentation: A 40-year-old Hispanic male with a history of diabetes mellitus presented with recurrent febrile episodes. His temperature on admission was 41.6oC associated with seizure-like activity requiring intubation. Labs were significant for WBC 1,800, platelets 85,000, creatinine 1.53, AST 178, ALT 199, ALP 254, and HA1c 10.3%. RUQ ultrasound showed a hepatic lesion concerning for abscess. CT angiography indicated a 5 x 4 x 3 cm left hepatic lobe mass. His hospital course was complicated with septic shock, DIC, ischemic hepatitis, and acute kidney injury. Blood cultures grew K. pneumoniae. He was treated with broad spectrum antibiotics which were de-escalated to ceftriaxone. His liver abscess was intended for CT-guided drainage, but was complicated with an active arterial bleed requiring massive transfusion protocol and IR coil embolization.
Discussion: Klebsiella pneumoniae liver abscess (KPLA) is an emerging infection with predominance in Southeast Asia. In the US, it is increasingly recognized as the leading cause of liver abscess in the absence of hepatobiliary disease and commonly found in Asian and Hispanic populations. Patients with KPLA usually present with fevers, chills, and RUQ pain, but some have nonspecific symptoms including nausea, vomiting, diarrhea, and jaundice. KPLA should be considered in any patient with liver mass in the setting of septicemia as early diagnosis and treatment is associated with favorable outcomes.Our patient was a Hispanic diabetic male with no recent travel history presenting with vague symptoms of fevers and seizure-like activity. Early recognition of KPLA with prompt surgical drainage and third-generation cephalosporins are mainstays of treatment; however, if not identified early, it can progress to metastatic disease involving the central nervous system, eyes, and lungs. Given our patient’s presentation, there was a delay in source control with drainage of the abscess, which ultimately led to his progression into septic shock and DIC.
Conclusions: KPLA is classically seen in individuals from Southeast Asia living with diabetes mellitus, but its prevalence is growing worldwide, especially in the US. KPLA should be suspected in any diabetic with unclear symptoms of septicemia and a single liver lesion to reduce and prevent life threatening complications.