Korean J Gastroenterol.  2015 Oct;66(4):237-241. 10.4166/kjg.2015.66.4.237.

A Case of Delayed-onset Multiple Metastatic Infection following Liver Abscess

• Lee KH
• Moon SY
• Kim IA
• Kwon SY
• Kim JH
• Choe WH
• Kwon YW

• KMID: 2373348
• DOI: http://doi.org/10.4166/kjg.2015.66.4.237

Abstract

Klebsiella pneumoniae liver abscess has a tendency to spread to distant sites early in the course of disease and to involve multiple organs synchronously. A 59-year-old male was admitted because of liver abscess accompanied by fever and abdominal pain. The patient underwent percutaneous catheter drainage and received intravenous antibiotics. Symptom relief was achieved after the treatment as well as marked reduction in the size of the abscess. Despite proper treatment of the liver abscess, however, patient developed multiple metastatic infections in a non-concurrent manner: left and right endophthalmitis, psoas abscess, and infectious spondylitis at 5, 23, 30 and 65 days after initial manifestations of liver abscess, respectively. Each infectious episode followed one another after resolution of the former one. For each episode of metastatic infections, the patient promptly underwent treatment with systemic and local antibiotics, interventional abscess drainage, and surgical treatments as needed. The patient fully recovered without sequelae after the use of intravenous antibiotics for an extended period of time. Herein, we report a case of K. pneumoniae liver abscess complicated with delayed-onset multiple metastatic infections.

Keyword

Liver abscess, pyogenic; Endophthalmitis; Psoas abscess; Spondylitis; Klebsiella pneumoniae

MeSH Terms

Anti-Bacterial Agents/therapeutic use
Ceftriaxone/therapeutic use
Drainage
Endophthalmitis/diagnosis/drug therapy
Humans
Injections, Intravenous
Klebsiella Infections/complications/*diagnosis/drug therapy
Klebsiella pneumoniae/isolation & purification
Liver Abscess/*diagnosis/etiology
Male
Middle Aged
Psoas Abscess/diagnosis/etiology
Spondylitis/diagnosis/drug therapy
Tomography, X-Ray Computed
Anti-Bacterial Agents
Ceftriaxone

Figure

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  Fig. 1. (A) Initial abdominal CT scan shows multiple liver abscesses with the largest one in segment 7 (arrow). (B) Fluoroscopy image shows properly placed percutaneous catheter within the liver abscess.

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  Fig. 2. (A) Initial abdominal CT scan shows no abscess formation in both psoas muscles. (B) Abdominal CT scan taken after 30 days reveals abscess formation in left psoas muscle (arrow).

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  Fig. 3. (A) Follow-up CT scan taken after 60 days shows irregular bone destruction and paravertebral enhancing soft tissue lesion (arrow) at L3 upper endplate. (B) Sagittal T1-weighted scan shows disc space narrowing and paravertebral inflammatory mass formation at L2–3 level (arrow).

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  Fig. 4. Clinical course of the patient. RUQ, right upper quadrant; PCD, percutaneous catheter drainage; IVI, intravitreal injection; AMK, amikacin; CFZ, ceftazidime; MTR, metronidazole; CFX, ceftriaxone; CPF, ciprofloxacin; PPR-TZB, piperacillin-tazobactam; AMX-CLV, amoxicillin- clavulanate; LVF, levofloxacin; IV, intravenous; PO, per oral.

Reference

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