One case of invasive Klebsiella pneumonia liver abscess syndrome complicated with hepatic vein thrombosis and review of the literature

doi:10.3877/cma.j.issn.1674-6902.2025.01.019

Abstract

Abstract:

Objective

To investigate the clinical manifestations，diagnostic strategies，and treatment options for invasive Klebsiella pneumoniae liver abscess syndrome （IKLAS），aiming to enhance clinicians′ability to recognize and manage IKLAS at an early stage.

Methods

A case admitted to our hospital on April 16，2024 was selected on the clinical data of a diabetic patient complicated with IKLAS，including symptoms，imaging studies，laboratory tests，and treatment process，supplemented by a review of relevant literature.

Results

A 45-year-old male with no significant medical history was admitted due to a 3-week history of cough，sputum，and fever，which worsened with chest pain over the past 3 days.Chest CT revealed multiple pulmonary nodules，hilar and mediastinal lymphadenopathy，and a hypodense lesion in the right lobe of the liver.Subsequent contrast-enhanced chest CT showed enlargement of the pulmonary nodules with cavitation，vascular feeding signs，and progression of patchy infiltrates and effusions，along with mediastinal lymphadenopathy.Contrast-enhanced abdominal CT indicated a hypodense hepatic lesion，suggesting liver abscess with hepatic vein thrombosis.Blood cultures and bronchoalveolar lavage metagenomic next-generation sequencing（mNGS）both identified Klebsiella pneumoniae，with a positive string test.Random blood glucose was 21.00 mmol/L，and glycated hemoglobin was 12.9%，leading to a diagnosis of diabetes complicated by IKLAS.After upgrading antibiotic therapy to imipenem-cilastatin combined with cefoperazone-sulbactam，the patient′ s symptoms significantly improved，body temperature normalized，and follow-up CT showed marked resolution of pulmonary and hepatic lesions，resulting in discharge with improvement.

Conclusion

The clinical manifestations of diabetes complicated by IKLAS are insidious and rapidly progressive，often leading to delayed diagnosis and treatment.For diabetic patients with liver abscess，a high suspicion of Klebsiella pneumoniae infection should be maintained，with attention to common sites of invasion.Early diagnosis，prompt administration of sensitive antibiotics，and necessary abscess drainage are crucial for improving prognosis.

Key words: Hypervirulent Klebsiella pneumonia, Invasive Klebsiella pneumoniae liver abscess syndrome, Diabetes, Hepatic vein thrombosis, Literature review

Rongrong Chen, Wensen Ding, Eryun Qin, Eryun Qin, Nini Wang, Qing Zhang, Chengshi Zhang, Ming Liu, Yunfeng Zhao, Changwen Tang. One case of invasive Klebsiella pneumonia liver abscess syndrome complicated with hepatic vein thrombosis and review of the literature[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(01): 115-120.

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References 39

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