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Klebsiella pneumoniae liver abscesses are becoming more prevalent in the United States and have the ability to spread to several sites via septic embolization. 8-15% of patients have infections at other anatomical sites which is considered invasive K. pneumoniae liver abscess syndrome (IKPLAS). An otherwise healthy 42-year-old Vietnamese man who immigrated to the United States six years prior presented to the emergency department with a nine-day history of back pain. The patient reported his pain worsened acutely just prior to presentation when lifting a heavy object. He also described numbness of the left leg. At presentation, the patient was septic. Because of this, a MRI of the lumbar spine was obtained which demonstrated multiple paraspinal and gluteal region abscesses. A chest CT demonstrated a 2cm right hepatic lobe hypoattenuating lesion suggestive of an abscess as well as multiple pulmonary nodules with peripheral and upper lobe predominance. Blood cultures drawn prior to initiation of antibiotics grew out Klebsiella pneumoniae. Given the patients ethnic background and the organism isolated, the liver lesion was suspected as the primary abscess, with hematogenous dissemination to the lungs, paraspinal and gluteal regions, this being consistent with IKPLAS. The patient underwent drainage of the piriformis muscle abscess which also yielded K. pneumoniae. When cultures returned positive for K. pneumoniae, the antibiotic regimen was narrowed to ceftriaxone based on organism susceptibility. Despite appropriate antibiotic therapy, he went on to develop further abscesses as well osteomyelitis of the L1 and L2 vertebrae. He underwent subsequent abscess drainage after which the patient defervesced and his back pain improved. The patient was eventually discharged on ceftriaxone 2gm every 12 hours and received a total of eight weeks of antibiotics. Invasive Klebsiella pneumoniae liver abscesses syndrome (IKPLAS) is a rare clinical disease entity defined as a liver abscess and disseminated Klebsiella infection. It is often seen in patients of Asian descent and is increasing in prevalence within the United States. IKPLAS is associated with a high degree of morbidity and mortality. It should be considered in septic patients who are found to have liver abscesses and are of Asian descent.'


Presented at American College of Physicians New Mexico Chapter Scientific Meeting, 11/07/2014, Albuquerque, NM.