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Case Reports
. 2025 Jul 7;17(7):e87412.
doi: 10.7759/cureus.87412. eCollection 2025 Jul.

Invasive Klebsiella pneumoniae Causing Concurrent Liver and Pulmonary Abscesses: Successful Management With Prolonged Oral Amoxicillin-Clavulanate

Mohammed Y Ishag  1   2 , Abdu Latif Alsuleimani  3
Affiliations
Case Reports

Invasive Klebsiella pneumoniae Causing Concurrent Liver and Pulmonary Abscesses: Successful Management With Prolonged Oral Amoxicillin-Clavulanate

Mohammed Y Ishag et al. Cureus. .

Abstract

We report a rare case of a 59-year-old male patient with poorly controlled diabetes mellitus who presented with concurrent hepatic and pulmonary abscesses. Imaging revealed a large septated hepatic lesion and multiple bilateral pulmonary cavities. Cultures from blood and drained hepatic pus confirmed Klebsiella pneumoniae. Despite the lack of genomic testing, the clinical course was consistent with invasive Klebsiella pneumoniae syndrome (IKPS). The patient was treated successfully with prolonged intravenous and oral amoxicillin-clavulanate over six months, along with percutaneous drainage of the hepatic abscess. Follow-up imaging demonstrated near-complete resolution of both liver and lung lesions. This case highlights the importance of early source control and extended culture-guided antibiotic therapy in managing severe invasive Klebsiella infections in immunocompromised patients.

Keywords: diabetes mellitus (dm); hypervirulent klebsiella pneumoniae (hvkp); invasive klebsiella pneumoniae liver abscess syndrome (ikplas); invasive klebsiella pneumoniae syndrome (ikps); outpatient parenteral antibiotic therapy (opat) program.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. An abdominal ultrasound revealed a solid focal mass in the right hepatic lobe measuring 10 x 8.5 cm with mixed echotexture and cystic changes
Figure 2
Figure 2. Contrast-enhanced CT chest showed multiple bilateral pulmonary cavitary lesions, largest in the right lower lobe measuring 29 x 44 x 33 mm
Figure 3
Figure 3. Contrast-enhanced CT showed a large septated mass in the right hepatic lobe (88 x 61 x 84 mm) and an adjacent mass (36 x 26 x 39 mm) with a bulky pancreatic head and dilated pancreatic duct (9 mm)
Figure 4
Figure 4. An MRI of the liver showed a large septated cystic hepatic lesion (9.4 x 7.3 x 9.4 cm)
Figure 5
Figure 5. Contrast-enhanced CT after four months of treatment showed a reduction of the hepatic lesion measuring about 28 x 20 x 15 mm
Figure 6
Figure 6. Contrast-enhanced CT showed the hepatic lesion with marked reduction in size and density appearing as subtle irregular faint hypodensity
Figure 7
Figure 7. CT chest demonstrated the right lower lobe lesion, appearing as air cyst/thin-walled cavity measuring 5 x 7 x 13 mm surrounding with linear atelectatic bands
See this image and copyright information in PMC

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