A Case of Klebsiella pneumoniae Liver Abscess Which Progressed to Pyomyositis and Infected Aneurysm of Aorta

Klebsiella pneumoniae causes pyogenic infections in various sites, with the risk of which increases in patients with diabetes mellitus. Recently, K. pneumoniae has emerged as a leading cause of pyogenic liver abscess. Primary liver abscess caused by K. pneumoniae in the absence of underlying hepatobiliary disease is commonly associated with metastatic infections such as endophthalmitis, meningitis, brain abscess and infection in other sites. We experienced a case of K. pneumoniae liver abscess associated with septic metastatic lesions including pyomyositis and infected aneurysm of aorta. Despite the aggressive management with antibiotics, surgical pus drainage and aortic bypass graft, patient died of ventilator associated pneumonia and multiorgan failure. Our experience suggests that clinicians should be alert to septic metastatic infections when they treat a patient with K. pneumoniae liver abscess.

A Case of Klebsiella pneumoniae Liver Abscess Which Progressed to Pyomyositis and Infected Aneurysm of Aorta

Klebsiella pneumoniae causes pyogenic infections in various sites, with the risk of which increases in patients with diabetes mellitus. Recently, K. pneumoniae has emerged as a leading cause of pyogenic liver abscess. Primary liver abscess caused by K. pneumoniae in the absence of underlying hepatobiliary disease is commonly associated with metastatic infections such as endophthalmitis, meningitis, brain abscess and infection in other sites. We experienced a case of K. pneumoniae liver abscess associated with septic metastatic lesions including pyomyositis and infected aneurysm of aorta. Despite the aggressive management with antibiotics, surgical pus drainage and aortic bypass graft, patient died of ventilator associated pneumonia and multiorgan failure. Our experience suggests that clinicians should be alert to septic metastatic infections when they treat a patient with K. pneumoniae liver abscess.

Hepatic Cyst Rupture in a Hemodialysis Patient with Polycystic Kidney Disease / 대한신장학회지

Autosomal dominant polycystic kidney disease (ADPKD) is usually accompanied with cystic change of other organs, especially in liver. Although hepatic cysts may be presented with abdominal pain or infected cysts, rupture of hepatic cyst is rarely encountered. A 74-year-old female undergoing maintenance hemodialysis for ADPKD-induced end stage renal disease was admitted because of abdominal pain. She recently received intermittent urokinase instillation into her cuffed internal jugular venous catheter. During the admission, a sudden onset of diffuse abdominal pain occurred after hemodialysis and repeated urokinase instillation. The abdominal CT revealed rupture of hepatic cysts with perihepatic fluid collection. With supportive care and heparin-free hemodialysis, symptoms were improved. The abdominal CT taken after 3 weeks showed no evidence of hepatic cyst rupture. The possibility of hepatic cyst rupture should be considered when abdominal pain occurs in dialysis patients with ADPKD. We need to be very cautious when they are exposed to anticoagulants or thrombolytic agents.