Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2016; 22(9): 2861-2866
Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2861
Klebsiella pneumoniae invasive liver abscess syndrome with purulent meningitis and septic shock: A case from mainland China
Yun Qian, Chi-Chun Wong, San-Chuan Lai, Zheng-Hua Lin, Wei-Liang Zheng, Hui Zhao, Kong-Han Pan, Shu-Jie Chen, Jian-Min Si
Yun Qian, San-Chuan Lai, Zheng-Hua Lin, Shu-Jie Chen, Jian-Min Si, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Yun Qian, San-Chuan Lai, Zheng-Hua Lin, Shu-Jie Chen, Jian-Min Si, Institute of Gastroenterology, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Chi-Chun Wong, Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, the Chinese University of Hong Kong, Hong Kong, China
Wei-Liang Zheng, Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Hui Zhao, Emergency Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Kong-Han Pan, Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Author contributions: Qian Y and Si JM designed the report; Qian Y and Wong CC wrote the manuscript; Lai SC, Lin ZH and Chen SJ collected the patient’s clinical data; Zheng WL, Zhao H and Pan KH were attending doctors and performed clinical treatment; Si JM proofread and revised the manuscript; all authors approved the version to be published.
Supported by the National Natural Science Foundation of China, No. 81372623; and the Zhejiang Province Key Science and Technology Innovation Team, No. 2013TD13.
Institutional review board statement: The study was reviewed and approved by the Sir Run Run Shaw Hospital Institutional Review Board.
Informed consent statement: Informed consent has been obtained and is available from the corresponding author.
Conflict-of-interest statement: All authors declared no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian-Min Si, MD, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. jianmin_si@zju.edu.cn
Telephone: +86-571-86006144 Fax: +86-571-86006144
Received: September 16, 2015
Peer-review started: September 16, 2015
First decision: November 5, 2015
Revised: November 19, 2015
Accepted: December 8, 2015
Article in press: December 8, 2015
Published online: March 7, 2016
Processing time: 168 Days and 12.2 Hours
Abstract

We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liver abscess, septic shock, purulent meningitis and metastatic hydrocephalus. Upon admission, the clinical manifestations, laboratory and imaging examinations were compatible with a diagnosis of K. pneumoniae primary liver abscess. Her distal metastasis infection involved meningitis and hydrocephalus, which could flare abruptly and be life threatening. Even with early adequate drainage and antibiotic therapy, the patient’s condition deteriorated and she ultimately died. To the best of our knowledge, this is the first case of K. pneumoniae invasive liver abscess syndrome with septic meningitis reported in mainland China. Our findings reflect the need for a better understanding of the epidemiology, risk factors, complications, comorbid medical conditions and treatment of this disease.

Keywords: Invasive liver abscess syndrome; Pyogenic liver abscess; Klebsiella pneumonia; Meningitis; Septic shock

Core tip: Invasive liver abscess syndrome due to Klebsiella pneumonia (K. pneumoniae) has been emerging worldwide over the past 2 decades, especially in the Asia Pacific region. K. pneumoniae liver abscess with metastatic meningitis is a rare and devastating complication. To our knowledge, this is the first case of invasive liver abscess syndrome with septic meningitis due to K. pneumoniae reported in mainland China.