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Chest Infections |

Multifocal Pneumonia Caused by Klebsiella pneumoniae Liver Abscess Syndrome

Julie Lai*, MD; Rene Franco, MD
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Einstein Medical Center, Philadelphia, PA


Chest. 2012;142(4_MeetingAbstracts):275A. doi:10.1378/chest.1389654
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Abstract

SESSION TYPE: Infectious Disease Student/Resident Case Report Posters III

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Klebsiella pneumoniae liver abscess syndrome (KLAS) is a distinctive clinical condition that was first described in Taiwan and is rarely reported in the United States (US).

CASE PRESENTATION: A 37 year-old Hispanic male from Guatemala who immigrated to the US one year ago, complained of 5 days of generalized abdominal and right-sided chest pain associated with fever, chills and shortness of breath. He denied any significant past medical history. He presented with tachycardia, tachypnea, fever of 102 F, blood pressure of 93/51mmHg and was hypoxic. Remarkable findings on physical examination included bilateral rales, abdominal right upper quadrant tenderness and hepatomegaly. Laboratory studies showed platelets of 15,000 mcL, a total bilirubin of 2,3 mg/dl , direct bilirubin of 1 mg/dl, AST 219 IU/L and ALT 235IU/L. His clinical condition rapidly deteriorated requiring intubation and vasopressors. A CT of the thorax showed bilateral multifocal pneumonia and a 6cm fluid collection on the right hemithorax consistent with empyema. An abdominal CT showed a 15cm x 17cm cystic mass with multiple septations on the right hepatic lobe. Blood, bronchial wash and liver cyst aspirate grew Klebsiella pneumoniae which was sensitive to cephalosporins. Appropriate antibiotics were started and a percutaneous drainage was initially placed. Given his persistent fever, laparoscopic drainage of the liver abscess was ultimately required. Subsequently, the patient remained afebrile and complete functional recovery was observed after 4 weeks of oral antibiotics.

DISCUSSION: Klebsiella pneumoniae liver abscess syndrome is a community-acquired infection. Typical presentation includes fever, abdominal pain and pleuritic chest pain. Distant metastasis, the salient feature of the disease, can occur in 7-12 % of patients, with meningeal and ophthalmic involvement yielding poor prognosis. Diabetes mellitus and Asian descent are known risk factors. Majority of cases occur in Asia, and in the US most patients are of Asian descent. Most KLAS cases are caused by the K1 serotype, whose hallmark is the mucoviscosity-associated gene A that confers virulence by the production of a thick polysaccharide capsule which prevents phagocytosis. Percutaneous drainage and appropriate antibiotics are the mainstream treatment. Surgical intervention may be required if the patient fails to respond in 4-7 days, as occurred in our case.

CONCLUSIONS: Due to the emergence of KLAS in the US, raising awareness of this distinctive syndrome is of utmost importance to achieve the best care for these patients.

1) McIver C, Janda J. Pathophysiology and laboratory identifi cation of emerging hepatovirulent Klebsiella pneumoniae. Clin Microbiol Newsl. 2008;30:127-31.

DISCLOSURE: The following authors have nothing to disclose: Julie Lai, Rene Franco

No Product/Research Disclosure Information

Einstein Medical Center, Philadelphia, PA

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