Primary Liver Abscess and Septic Pulmonary Emboli in a Diabetic Patient: An Emerging Invasive Syndrome

BACKGROUND: During the past 2 decades a distinct invasive syndrome that causes Klebsiella pneumoniae liver abscess with bacteremia and metastatic infections has been increasingly reported in Asia. This syndrome is emerging as a global disease and a few cases have recently been reported in North America.
CASE REPORT: Our patient was a 52-year-old diabetic Puerto Rican woman complaining of nausea and vomiting with associated fever, diarrhea, and altered mental status for 3 days and presenting with leukocytosis, pancreatitis, elevated liver enzymes, and biochemical criteria of diabetic ketoacidosis (DKA). An abdominopelvic CT showed a large gas-filled necrotic lesion at the right hepatic lobe with internal fluid and debris consistent with a hepatic abscess. Blood cultures were positive for K. pneumoniae bacteremia. Days later the patient developed shortness of breath and hypoxemia that required endotracheal intubation. A chest CT was performed and several nodules were seen bilaterally at the lung periphery consistent with septic pulmonary emboli. Hepatic drainage was placed, fluid was cultured, and findings were positive for monomicrobial K. pneumoniae, establishing the diagnosis of invasive Klebsiella syndrome.
CONCLUSIONS: The invasiveness of K. pneumonia is related to the hypermucoviscous phenotype. Diabetes mellitus has been associated as a predisposing factor to this infection. To the best of our knowledge, there are few cases of this syndrome reported in the United States and Puerto Rico. This invasive syndrome seems to be spreading outside Asia and many aspects remain unknown. Further investigation is needed to find why Asian populations are prone to this disorder and to elucidate the reason of its emergence in North America.

Keywords: Diabetic Ketoacidosis, Klebsiella pneumoniae, liver abscess