BackgroundKlebsiella pneumonia is a well-known human pathogen, and recently, a distinct invasive syndrome caused by K. pneumoniae serotypes K1 and K2 has been recognized in Southeast Asia. This syndrome is characterized by primary liver abscess and extrahepatic complications resulting from bacteremic dissemination. We report the first adult case of primary liver abscess caused by the definite K2 serotyped pathogen, with endogenous endophthalmitis in Japan.Case presentationA 64-year-old woman was admitted to a nearby hospital for a high fever and diarrhea. She had visual loss of her right eye, renal dysfunction, and thrombocytopenia within 24 h from admission. She was transferred to our institution. On admission, she had no alteration of mental status and normal vital signs; however, she had almost complete ablepsia of the right eye. Laboratory data showed severe inflammation, liver dysfunction, thrombocytopenia, an increased serum creatinine level, and coagulopathy. Computed tomography showed a low density area in the right lobe of the liver. Invasive liver abscess syndrome probably caused by K. pneumonia was highly suspected and immediately administered broad-spectrum antibiotics for severe sepsis. Concurrently, endogenous endophthalmitis was diagnosed, and we performed vitrectomy on the day of admission. The blood culture showed K. pneumoniae infection. Percutaneous drainage of the liver abscess was also performed. Although she was discharged in a good general condition on day 22, she had complete ablepsia of the right eye. The K2A gene was detected by polymerase chain reaction (PCR), which is consistent with the K2 serotype. PCR was also positive for the virulence-associated gene rmpA. Final diagnosis was invasive liver abscess syndrome caused by K2 serotype K. pneumonia.ConclusionsAlthough the primary liver abscess caused by K. pneumoniae with a hypermucoviscous phenotype is infrequently reported outside Southeast Asia, physicians should recognize this syndrome, and appropriate diagnosis and treatment is essential for saving patients’ lives and preserving organ function, especially for visual acuity.
A 66-year-old man was admitted to our intensive care unit because of severe pneumonia. He was treated with mechanical ventilation, antibiotics, and corticosteroids, but muscle weakness developed rapidly. His muscle strength declined to a Medical Research Council scale sum score of 18/60;thus, a diagnosis of intensive care unit-acquired weakness(ICU-AW)was made. The results of nerve conduction studies were compatible with critical illness polyneuropathy. Mechanical ventilation was required for 95 days because of continuous respiratory failure. Rehabilitation began at 48 hours after hospitalization and was continued to prevent immobilization even when he was mechanically ventilated. However, orthostatic hypotension developed and inhibited mobility training. Physical and occupational therapies provided muscle strengthening exercises followed by a progressive mobility program that assisted him to raise his head, sit on the edge of the bed, and stand up. The intervention was performed within safety criteria of vital signs and the rating of perceived exertion(RPE)Borg scale between 11 and 13. It resulted in the attenuation of orthostatic hypotension and the recovery of muscle strength. He finally achieved independence in activities of daily living and the ability to walk without help after 271 days of admission. This case report suggests that long-term rehabilitation within safety criteria of vital signs and RPE Borg scale between 11 and 13 is safe and feasible without overuse weakness for ICU-AW with orthostatic hypotension.
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