Aug 2026· International journal of surgery case reports· 0 citations· 24 references
TL;DR
A 77-year-old woman who presented with fever and right upper quadrant abdominal pain was diagnosed with a second episode of PLA within 3 months, caused by hypervirulent Kp, and whole-genome sequencing identified the isolate as hypervirulent Kp (hvKp) sequence type 23 (ST23).
Abstract
Pyogenic liver abscess (PLA) has traditionally been considered prevalent in Asia. However, its incidence is increasing in Europe.
Klebsiella pneumoniae
(Kp) has emerged as the leading causative pathogen, and hypervirulent strains pose a higher risk of invasive disease and metastatic complications, such as endogenous endophthalmitis (EE).
The case describes a 77-year-old woman who presented with fever and right upper quadrant abdominal pain. She was diagnosed with a second episode of PLA within 3 months, caused by Kp. Despite prompt antimicrobial therapy and percutaneous transhepatic drainage, the patient developed acute vision loss in the left eye during hospitalization. Ophthalmologic assessment confirmed EE secondary to bacteremia. Whole-genome sequencing identified the isolate as hypervirulent Kp (hvKp) sequence type 23 (ST23). While the liver abscess resolved following treatment, the patient sustained permanent loss of vision in the affected eye despite aggressive medical and surgical management.
This case illustrates the invasive nature of hvKp and its potential for recurrence and metastatic complications. Improved recognition through targeted virulence testing is essential to avoid underdiagnosis.
This case highlights the aggressive nature of hvKp. Early recognition of systemic and ocular symptoms, prompt ophthalmologic evaluation, and timely source control are essential. Optimal management requires multidisciplinary collaboration and the use of molecular diagnostics, including whole-genome sequencing, to identify hypervirulent lineages and support surveillance.
Emerging strains of hypervirulent
Klebsiella pneumoniae
are increasingly recognized to cause life-threatening, community-acquired infections in persons without significant immunocompromise. Beyond the association with pyogenic liver abscesses and bacteremia, additional sites of involvement include skin and soft tissue, bone, eyes, and the central nervous system. Individuals with diabetes mellitus and originating from the Asian Pacific Rim appear to be at higher risk for colonization and infection. Genetic testing for defining virulence factors was recently proposed as a standard for differentiating hypervirulent from classical
K. pneumoniae
strains.
Retrospective review of a
K. pneumoniae
infection in a middle-aged male.
The patient had untreated type 2 diabetes, hypertension, and obesity, and immigrated from a southeast Asian country to Canada over one decade prior. He presented with profound refractory septic shock leading to progressive multiorgan system failure. In totality, the infection involved necrotizing fasciitis of bilateral legs, bilateral emphysematous pyelonephritis, emphysematous cholecystitis, multifocal necrotizing pneumonia, and bacteremia notably without liver abscess.
K. pneumoniae
was later isolated from blood and sputum. Whole-genome sequencing identified
K. pneumoniae sensu stricto
with K1 capsule belonging to sequence type 23 and harbouring the characteristic virulence genes
iucA
,
iroB
,
peg-344
,
rmpA
, and
rmpA2
.
This case demonstrates a remarkable extent of dissemination and expands the known clinical spectrum for hypervirulent
K. pneumoniae
infection. Genetic testing has the potential to proactively identify hypervirulent strains and inform clinical management. Heightened clinical vigilance, development of accessible rapid diagnostic tools, and further research into treatment strategies are needed for this emerging pathogen.
Victor Mocanu, Q. Salehmohamed, Kelsey Wagner et al.· Journal of the Association o...· 0 citations
Objective: We report the case of a 75-year-old woman who presented with a hypoechoic liver mass and a two-week history of frequent urination, low-grade fever, and fatigue for 2 weeks. Case report: A liver abscess was diagnosed based on an elevated inflammatory response and imaging findings, and was drained percutaneously. Klebsiella pneumoniae was isolated from both the urine and pus cultures, indicating an invasive infection secondary to a urinary tract source. The following day, the patient experienced ocular pain, blurred vision, and conjunctival hyperemia and was diagnosed and treated for endophthalmitis. After treatment, she became blind in the right eye; however, her vision in the left eye was preserved. Conclusion: This case highlights that invasive liver abscess syndrome should be considered in patients with K. pneumoniae infection and that liver abscesses should be treated promptly in patients with extrahepatic symptoms.
Hiroyuki Ariga, Iori Izumi, Naoki Iso et al.· Journal of Rural Medicine· 0 citations
Treating carbapenem-resistant Klebsiella pneumoniae (CRKP) is challenging, particularly when resistance is mediated by New Delhi metallo-β-lactamase (NDM). Clinical experience with fixed-combination aztreonam–avibactam (ATM–AVI) in young infants remains extremely limited. Here, we report a case of a 2-month-old boy who underwent emergency laparotomy for intestinal obstruction owing to small bowel volvulus with segmental necrosis, followed by bowel resection and reanastomosis. His postoperative course was complicated by respiratory failure, coagulopathy, septic shock, recurrent abdominal distension, and massive ascites. Blood cultures were negative, whereas metagenomic next-generation sequencing of blood detected K. pneumoniae and Enterococcus faecium. Owing to the worsening of his condition, diagnostic paracentesis and repeat laparotomy were performed, revealing an anastomotic leak. Intraoperative pus culture yielded bla NDM -positive CRKP. The isolate was resistant to carbapenems and ceftazidime–AVI but was susceptible to ATM–AVI, with a minimum inhibitory concentration of ≤4 mg/L. ATM–AVI was administered at 30 mg/kg every 8 h, based on the aztreonam component, for 14 days; linezolid and fluconazole were co-administered as part of the broader anti-infective regimen. The combination of definitive surgical source control, targeted antimicrobial therapy, and comprehensive intensive care successfully controlled the infection and stabilized his hemodynamics. The patient defervesced within 24 h of the first ATM–AVI dose. Inflammatory markers declined rapidly, allowing safe extubation. Follow-up abdominal cultures remained negative. No hepatic or renal toxicity was observed during treatment. This case suggests that, when combined with adequate surgical source control, ATM–AVI may represent a valuable mechanism- and susceptibility-guided pharmacological component in a multidisciplinary treatment paradigm for severe bla NDM -positive CRKP infections in selected infants.
Jie Liu, Xiaoli He, Wanling Zhao et al.· Frontiers in Pharmacology· 0 citations
Dengue fever is one of the most common mosquito-borne viral illnesses worldwide. Although most cases are selflimiting, concomitant bacterial infections may result in severe complications and increased mortality. A 32-year-old previously healthy male presented with a 7-day history of rash over the right side of the neck extending to the occipital region, 4 days of fever, vomiting, malaise, headache, neck swelling with restricted neck movements, and 1 day of cough and shortness of breath. Evaluation revealed neck cellulitis, bilateral pneumonia, thrombocytopenia, acute kidney injury, myocarditis, hepatic dysfunction, and methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. Dengue immunoglobulin M was positive. Despite initial broad-spectrum antibiotic therapy, the patient developed progressive necrotizing pneumonia requiring mechanical ventilation. Following escalation to targeted antimicrobial therapy together with adjunctive therapy, significant clinical improvement was observed, and the patient was discharged in stable condition. Severe bacterial coinfection should be considered in dengue patients with atypical clinical deterioration. Early recognition and prompt treatment of MSSA-associated necrotizing pneumonia may be life-saving.
Lexy Vijayan· Indian Journal of Case Repor...· 0 citations
Although varicella-zoster virus (VZV) infection is typically self-limiting in immunocompetent individuals, this case underscores its rare but fatal potential when complicated by appendicitis, hepatitis, and pneumonia. The rapid progression to septic shock in a healthy young adult makes this report novel and clinically significant. An 18-year-old previously healthy Iranian woman underwent an appendectomy, after which she developed diffuse varicella-like skin lesions. Polymerase chain reaction of peripheral blood confirmed VZV viremia. During hospitalization, she developed pneumonia, hepatitis, and septic shock requiring intensive care. Despite aggressive treatment, including intravenous acyclovir, broad-spectrum antibiotics, and hemodynamic support, she died from multiorgan failure seven days after admission. This case demonstrates that even common, typically benign infections (e.g., chickenpox) and routine surgical conditions (e.g., appendicitis) can culminate in fatal systemic complications in immunocompetent patients. Clinicians should maintain a high index of suspicion for atypical VZV presentations in adults, as early antiviral therapy may improve outcomes.
Mahnaz Arian, M. Gharib, S. A. Jamehdar et al.· Archives of Anesthesia and C...· 0 citations
Background Malignant and benign hepatic diseases may both present with systemic symptoms and necrotic liver cavities. Although rare and reported predominantly in East Asia, pyogenic liver abscess (PLA) can represent the initial manifestation of hepatocellular carcinoma (HCC), as necrotic tumors may mimic infectious abscesses. Case Presentation A 63‐year‐old Italian man presented with a 2‐week history of fever and right upper quadrant pain. Computed tomography revealed a multiloculated lesion with irregular margins and a solid component in the right hepatic lobe, suggestive of a liver abscess, and empirical tigecycline therapy was initiated. Low‐titer Entamoeba spp. IgG antibodies were detected, and percutaneous aspiration yielded material initially mischaracterized as “anchovy paste,” raising suspicion for amoebic liver abscess. However, the patient failed to improve despite appropriate antiprotozoal therapy. Subsequent percutaneous drainage led to cavity resolution and symptom relief; all microbiological and parasitological tests were negative, and repeat Entamoeba serology became negative. Concurrent biopsy of the solid component revealed well‐differentiated pseudoglandular HCC. Magnetic resonance imaging demonstrated a biliary fistula associated with the neoplastic lesion, supporting a diagnosis of PLA secondary to HCC. The patient underwent right hepatectomy, complicated by intraoperative abscess rupture and postoperative intra‐abdominal abscesses caused by vancomycin‐resistant Enterococcus faecium. Discussion PLA presenting as the initial manifestation of HCC is associated with poor prognosis, largely due to diagnostic delays. Limited clinical experience outside high‐prevalence regions and nonspecific clinical, laboratory, and imaging findings contribute to underrecognition of malignancy. Positive microbiological or serological results and transient clinical improvement during antimicrobial therapy do not exclude an underlying neoplasm. Liver biopsy and close radiologic follow‐up are essential in atypical or treatment‐refractory cases. Conclusion PLA as a presenting feature of HCC is unusual, especially in Europe, yet poses substantial diagnostic and therapeutic challenges. Increased clinical awareness and early histopathological evaluation are crucial to avoid delayed oncologic diagnosis.
F. Siviero, M. A. Muslimani, Sonia Lerta et al.· Case Reports in Hepatology· 0 citations
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