A Case of Invasive Liver Abscess Syndrome Encountered at a Hospital with a Limited Capacity to Perform Tests

Abstract

A 73-year-old woman with the chief complaint of fever visited our hospital and was admitted with the diagnosis of liver abscess and calculous cholecystitis. Klebsiella pneumoniae (KP) was isolated on blood culture. On hospital day 6, as the patient presented with signs of endophthalmitis in her left eye, she was referred to the department of ophthalmology of our hospital, where she was suspected as having metastatic endophthalmitis. Her vision had decreased to just hand motions, and she was referred to a university hospital for ophthalmic surgery. After the transfer, the liver abscess was drained, and KP was isolated by culture of the fluid. Her vision improved to counting fingers, and she was discharged from the university hospital. Liver abscess caused by mucoid-type KP leads to the invasive liver abscess syndrome, in which the abscess and inflammation metastasize to the whole body. Sequelae, such as blindness, are a concern. Polymerase chain reaction and string tests using culture samples are considered as being useful for prophylactic management of this condition. However, ophthalmological consultation should be considered before culture results are available at hospitals with a limited capacity to perform these tests.