A Case of Liver Abscess Associated with Hypermucoviscosity Klebsiella Pneumoniae Resolved by Complete Liver Resections of Liver Abscesses

Abstract

A 79-year-old male presented at our hospital with abdominal pain and fever. Contrast-enhanced computed tomography (CT) revealed a ruptured 10 cm liver abscess in the lateral sector (LS) and small abscesses in the right liver lobe. Percutaneous abscess drainage of the LS was performed, followed by antibiotic therapy. However, abscess drainage was inadequate because of the viscosity of the contents, and the patient did not recover from the worsening septic shock. A further CT scan 4 days after admission revealed that the abscess in the LS had increased in size. We decided to surgically remove the detectable abscesses to control the source of the infection. Therefore, the patient underwent lateral sectionectomy. The cut surface of the tissue exhibited a complex gyriform-like structure with mucinous substances. In addition, blood and abscess cultures and string test results suggested that liver abscesses were caused by hypermucoviscous Klebsiella pneumoniae (hmKp). Multiple remnant abscesses continued to increase in size, and wedge resection was performed 4 days later to remove three remnant abscesses. The patient's systemic condition improved, and he was discharged on postoperative day 23. The patient was successfully treated through complete resection of all the hmKp-associated liver abscesses.