Recurrent invasive liver abscess syndrome induced by Klebsiella pneumoniae with emerging drug resistance: a case report and literature review

Abstract

Background: Invasive liver abscess syndrome (ILAS) caused by hypervirulent Klebsiella pneumoniae (hvKp) is a life-threatening infection associated with high mortality, particularly when complicated by brain abscesses. The emergence of carbapenem-resistant hypervirulent K. pneumoniae (CR-hvKp) during treatment, driven by emerging resistance, poses significant therapeutic challenges.

Case presentation: We describe a 70-year-old diabetic male with recurrent ILAS who developed sequential multi-organ infections, including urinary tract infection, bacteremia, lung abscess, and brain abscess. Initial isolates were identified as carbapenem-susceptible; however, under prolonged antimicrobial pressure, they were transformed into CR-hvKp carrying the KPC gene. Treatment escalated from meropenem to ceftazidime-avibactam plus tigecycline, resulting in clinical improvement and discharge after 48 days.

Conclusion: This case highlights the critical challenge of emerging resistance in hvKp during prolonged therapy, emphasizing the need for early molecular surveillance, multidisciplinary collaboration, and optimized antibiotic stewardship to mitigate treatment failure in ILAS.

Keywords: Klebsiella pneumoniae; brain abscess; case report; emerging drug resistance; invasive liver abscess syndrome.

Figure 1

Initial multimodal imaging findings within 24 hours of admission; Chest CT, Abdominal CT, and Brain MRI. (A) A Chest CT scan shows multiple patchy hyperdense opacities in bilateral lungs. (B) An abdominal CT scan shows hypodense lesion in the right posterior hepatic lobe (arrow). (C) Axial MRI head shows mild enlargement of the supratentorial ventricular system, with fluid levels in the occipital horn of the lateral ventricle accompanied by hyperintensity on DWI (arrows).

Figure 2

Dynamic changes in key biomarkers following hospital admission.

Figure 3

Follow-up multimodal imaging findings during treatment: Chest CT, Abdominal CT, and Brain MRI. (A) A Chest CT scan shows bilateral cavitary pneumonia with right pleural effusion. (B) Multiple thin-walled pulmonary abscesses with rim enhancement (arrow). (C) Hepatic abscess (segment 6) with hepatic vein thrombosis (arrow). (D) Bilateral ring-enhancing cerebral lesions with DWI hyperintensity in ventricular posterior horns (arrow).