Infect Chemother.  2008 Dec;40(6):346-349. 10.3947/ic.2008.40.6.346.

Klebsiella pneumoniae Multi-organ Infection not Accompanied by Liver Abscess : Report of 2 Cases

• Seo JG
• Park JC
• Ahn HD
• Lee SY
• Kim JY
• Park YS
• Cho YK

• KMID: 1782304
• DOI: http://doi.org/10.3947/ic.2008.40.6.346

Abstract

Klebsiella pneumoniae is a pathogen that causes a wide range of infections in human, and has a tendency to metastasize to multiple organs. We report two rare cases of K. pneumoniae infection that have spread to multiple organs without being accompanied by liver abscess. A 59-year-old man (case 1) was admitted due to left knee pain. Microbiologic and radiologic studies revealed bacteremia, septic arthritis, pneumonia, prostatitis, and endophthalmitis caused by K. pneumoniae. A 48-year-old man (case 2) was admitted due to febrile sensation. Microbiologic and radiologic studies revealed bacteremia, pneumonia, urinary tract infection, endophthalmitis, and cerebritis caused by K. pneumoniae. With appropriate use of effective antibiotics and therapeutic measures, the patients recovered but with some sequelae.

Keyword

Klebsiella pneumoniae; Metastatic infection

MeSH Terms

Anti-Bacterial Agents
Arthritis, Infectious
Bacteremia
Endophthalmitis
Humans
Klebsiella
Klebsiella pneumoniae
Knee
Liver
Liver Abscess
Middle Aged
Pneumonia
Prostatitis
Sensation
Urinary Tract Infections
Anti-Bacterial Agents

Figure

• 

  Figure 1 (A) Bilateral pneumonia with pleural effusion in case 1. (B) Fluid collection, synovial thickening and enhancement on left knee joint in case 1.

• 

  Figure 2 (A) Pneumonia on both lungs in case 2. (B) Multiple encephalitis in case 2.

Reference

1. Ko WC, Paterson DL, Sagnimeni AJ, Hansen DS, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, Mulazimoglu L, Trenholme G, Klugman KP, McCormack JG, Yu VL. Community-acquired Klebsiella pneumoniae bacteremia, global differences in clinical patterns. Emerg Infect Dis. 2002. 8:160–166.

2. Kang CI, Kim SH, Bang JW, Kim HB, Kim NJ, Kim EC, Oh MD, Choe KW. Community-acquired versus nosocomial Klebsiella pneumoniae bacteremia: clinical features, treatment outcomes, and clinical implication of antimicrobial resistance. J Korean Med Sci. 2006. 21:816–822.

3. Tsay RW, Siu LK, Fung CP, Chang FY. Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection: risk factor for mortality and the impact of capsular serotypes as a herald for community-acquired infection. Arch Intern Med. 2002. 162:1021–1027.

4. Wang JH, Liu YC, Lee SS, Yen MY, Chen YS, Wang JH, Wann SR, Lin HH. Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 1998. 26:1434–1438.

5. Chung DR, Kang JM, Hong SS, Cho YK, Kim EO, Kim YS. Epidemiologic study of pyogenic liver abscess in Korea, 1989-1998. Clin Infect Dis. 1998. 27:950.

6. Lee KH, Hui KP, Tan WC, Lim TK. Klebsiella bacteraemia: a report of 101 cases from National University Hospital, Singapore. J Hosp Infect. 1994. 27:299–305.

7. Cheng DL, Liu YC, Yen MY, Liu CY, Wang RS. Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients. Arch Intern Med. 1991. 151:1557–1559.

8. Park SH, Choi SM, Nam KW, Kim SI, Wie SH, Kim YR, Moon IS, Kang MW. Two cases of Klebsiella pneumoniae liver abscess complicated with multiple septic metastatic lesions: Their association with diabetes mellitus. Korean J Infect Dis. 2001. 33:364–370.

9. Liu YC, Cheng DL, Lin CL. Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med. 1986. 146:1913–1916.

10. Chang FY, Chou MY. Comparison of pyogenic liver abscesses caused by Klebsiella pneumoniae and non-K. pneumoniae pathogens. J Formos Med Assoc. 1995. 94:232–237.

11. Chou FF, Kou HK. Endogenous endophthalmitis associated with pyogenic hepatic abscess. J Am Coll Surg. 1996. 182:33–36.

12. Oh TS, Ahn Y, Chang SD, Lee YK. A case of endogenous endophthalmitis caused by Klebsiella Pneumoniae from emphysematous pyelonephritis. J Korean Ophthalmol Soc. 2002. 43:1330–1334.

13. Park CH, Joo YE, Choi SK, Rew JS, Kim SJ. Klebsiella pneumoniae septic arthritis in a cirrhotic patient with hepatocellular carcinoma. J Korean Med Sci. 2004. 19:608–610.

14. Kim YS, Kim MK, Kim YO, Woon YD, Shin SJ, Kim HW, Chang YS, Bang BK, Yoon SA. A case of bilateral psoas abscess complicated by acute pyelonephritis due to Klebsiella pneumoniae. Korean J Nephrol. 2005. 24:1011–1015.

15. Kim BK, Lee JH, Lee SJ, Ki HK, Song KH, Kim DL, Kim SK. A case of necrotizing fasciitis caused by Klebsiella pneumoniae secondary to chronic otitis media. Korean J Med. 2007. 72:689–695.