Klebsiella pneumoniae-induced liver and prostate abscesses

A 72-year-old man with diabetes mellitus presented with a 2-day history of fever, lethargy, and shortness of breath. Upon admission, the patient was in a septic shock with severe respiratory distress, which required the administration of inotropic agents and mechanical ventilation. An urgent computed tomography (CT) scan of the abdomen and pelvis revealed a liver abscess in segment V and a prostate abscess (Figure 1). No physical examination findings indicated meningitis or endophthalmitis. He was administered an empirical antibiotic (intravenous piperacillin-tazobactam). Blood cultures revealed Klebsiella pneumoniae, which was susceptible to ampicillin-sulbactam. Consequently, we switched to ampicillin-sulbactam. However, the patient's clinical condition deteriorated, and he developed severe thrombocytopenia due to sepsis, which precluded surgical drainage. A 1-week follow-up scan revealed that the size of the liver and prostate abscesses had reduced slightly. Unfortunately, the patient passed away 3 weeks later because of a nosocomial infection.

FIGURE 1: A CT scan of the abdomen and pelvis showing (a) a liver abscess in segment V measuring 3.9 x 3.6 x 2.9 cm and (b) a prostate abscess measuring 3.5 x 3.2 x 3.7 cm.

Compared with classic K. pneumoniae strains, hypervirulent strains of Klebsiella pneumoniae are more likely to cause severe disseminated infections such as community-acquired infections, including liver abscesses, pneumonia, meningitis, and endophthalmitis¹. Prostate abscess is a rare complication of K. pneumoniae infection; however, in Taiwan, K. pneumoniae is the most common pathogen associated with prostate abscess, especially in patients with diabetes². The optimal management of K. pneumoniae-induced liver and prostate abscesses includes confirming via imaging, administering appropriate antimicrobial therapy, and ensuring adequate drainage³.