Abstract Introduction Klebsiella liver abscesses (KLA) are a severe tissue-invasive complication of Klebsiella pneumoniae infection. Since Klebsiella is a known gut colonizer, KLA most commonly develop in the setting of hepatobiliary disease via the biliary tract or intra-abdominal infection via the portal vein. KLA present clinically with fever and abdominal pain with corresponding lab findings of leukocytosis and transaminitis, nonspecific signs that can delay diagnosis and treatment. We present a case of recurrent Klebsiella bacteremia leading to KLA secondary to underlying colonic angioectasia. Case Presentation A 60-year-old female with history of pancreatic adenocarcinoma in sustained remission and recurrent Klebsiella bacteremia presented with encephalopathy, abdominal pain, and hematochezia. She had a recently noted liver mass on imaging with biopsy negative for malignancy. Post-biopsy course was complicated by iatrogenic hepatic artery pseudoaneurysm requiring embolization and subsequent portal vein thrombus. On admission, she was febrile, hypotensive, and tachycardic. Exam was notable for diffusely tender abdomen. Labs revealed acute blood loss anemia and thrombocytopenia. She developed shock requiring transfusion and vasopressor support. Blood cultures ultimately grew Klebsiella pneumoniae, and imaging revealed a new right hepatic lobe lesion. The patient underwent colonoscopy for ongoing hematochezia, revealing colonic angioectasias. Repeat imaging with MRI showed a new subcapsular rim-enhancing fluid collection in the right hepatic lobe. In the setting of her recurrent Klebsiella bacteremia and new lesions on interval imaging, there was high suspicion for KLA. She was treated with a prolonged course of antibiotics with imaging to monitor her liver lesions, as they were too small for drainage. Discussion In patients with complex medical histories, it can be challenging to diagnose rarer complications of disease. This patient's hematochezia acted as a distracting variable, while ultimately being a likely source for recurrent bacteremia seeding her liver. While hepatic seeding classically involves ascending infection via the biliary tract, this case illustrates a less commonly recognized route: hematogenous translocation across disrupted colonic mucosa, specifically at site of angioectasias. Mortality rates in patients with KLA range from 5 to 40%, as liver abscesses are difficult to treat and can precede metastatic infection. The management of liver abscess is challenging, particularly when lesions are small and not amenable to drainage. Prolonged, targeted antibiotic therapy with interval imaging is warranted to ensure resolution. Clinicians should maintain a high index of suspicion for hepatic abscesses in patients with recurrent Klebsiella bacteremia with associated colonic angioectasias, as early recognition and management can improve outcomes. This abstract is funded by: None
Kim et al. (Fri,) studied this question.