Successful hepatic resection for invasive Klebsiella pneumoniae large multiloculated liver abscesses with percutaneous drainage failure: A case report

Abstract

Background: Invasive Klebsiella-associated liver abscesses can progress rapidly and cause severe metastatic infections such as meningitis and hydrocephalus, which are associated with high morbidity and mortality. In patients with large multiloculated liver abscesses after failure of percutaneous drainage, rapid diagnosis of the abscess followed by hepatic resection is necessary for early recovery and to prevent severe secondary metastatic complications.

Case presentation: An 84-year-old woman with a large liver abscess and in septic shock was transferred to our hospital. Abdominal CT showed multiloculated liver abscesses 15 cm in diameter in the right lobe of the liver. We first performed percutaneous liver abscess drainage. The patient was managed in the intensive care unit, as well as treated with intravenous administration of meropenem followed by cefozopran according to the antibiogram. Klebsiella pneumoniae with invasive infection was confirmed by a string test in an isolated colony of K. pneumoniae; the K1 serotype with the rmpA and magA genes was determined by polymerase chain reaction and Sanger sequencing. Additional percutaneous liver abscess drainage was performed due to initial inadequate drainage. Although the abscess had shrunk to a diameter of 8 cm after drainage in 4 weeks, the patient recovered from sepsis, but still had low-grade fever (occasionally 38°C) and continued to have symptoms of chronic inflammation with persistent hyper mucus discharge from the liver abscess. Surgical resection was chosen to prevent prolonged hospitalization and ensure early recovery. A right posterior sectionectomy of the liver, including liver abscess, was performed. The post-operative course was uneventful, with no complications, and she was discharged after 18 days. There were no signs of abscess recurrence 1 year after surgery.

Conclusion: We present a case of successful hepatic resection after percutaneous drainage failure in a patient with invasive K. pneumoniae multiloculated liver abscess.

Keywords: K. pneumoniae; K1 serotype; Klebsiella-associated multiloculated liver abscess; hyper mucus discharge; percutaneous drainage failure.

FIGURE 1

Contrast-enhanced computed tomography images of the liver. (A) Multiloculated liver abscess (white arrows) occupying the right lobes of the liver extending across the right hepatic vein. (B) Coronal image revealing multiloculated liver abscess (white arrows) 15 cm in diameter.

FIGURE 2

Polymerase chain reaction (PCR) applied to the pus of the liver abscess. PCR with extracted DNA from the pus of the abscess revealed amplification of the Klebsiella pneumoniae serotype K1 specific locus (wzyKPK1), rmpA, and magA fragments that were detected by electrophoresis on 2.0% agarose.

FIGURE 3

Contrast-enhanced computed tomography images of the liver. (A) Right hepatic vein separated from the multiloculated liver abscess (white arrows). (B) Coronal image revealing multiloculated liver abscess (white arrows) with drainage tubes 8 cm in diameter.