A Case of a Type 2 Diabetic Patient with Pyogenic Liver Abscess and Metastatic Muscle Abscesses of the Lower Limb Caused by Klebsiella pneumoniae

Abstract

A 62-year-old man with a decade-plus history of diabetes mellitus admitted for fever and right lower limb swelling had hyperglycemia (515 mg/dl) with a 11.0% rise in HbA₁c. Abdominal computed tomography showed a 9.0×9.0 cm abscess in the right hepatic lobe. Magnetic resonance imaging of the right limb showed multiple abscesses. Cultures of blood and abscess fluid from the liver and right lower limb grew Klebsiella pneumoniae. The man responded successfully to percutaneous drainage of the liver abscess, surgical debridement of the foot, antibiotics, and insulin. Pyogenic liver abscess caused by Klebsiella pneumoniae is more frequent in diabetic than nondiabetic patients and tends to cause more metastatic lesions than non-Klebsiella pathogens. Physicians should therefore consider this condition in the management of septic diabetic patients with lower limb swelling.