Characteristics of Computed Tomography for Identifying Patients at High Risk of Endogenous Endophthalmitis Due to Klebsiella pneumoniae-Related Pyogenic Liver Abscess

Abstract

Endogenous endophthalmitis (EE) associated with Klebsiella pneumoniae (K. pneumoniae)-related pyogenic liver abscess (PLA) is one of the fatal complications of PLA and leads to loss of vision. Early diagnosis and treatment are important to save the patient’s vision. We investigated the characteristics of computed tomography (CT) in EE associated with K. pneumoniae-related PLA for the identification of the predictors of EE, in order to facilitate early diagnosis. A total of 274 patients diagnosed with K. pneumoniae-related PLA, including 15 patients with EE, were identified between January 2005 and December 2019. The clinical (age, gender, and underlying disease) and radiologic (the location, size, and number of abscesses) features were reviewed. In addition, the involvement of the adjacent vessels, such as the hepatic vein and portal vein, was carefully reviewed. A comparative analysis was performed between the EE and non-EE groups. Uni- and multivariate logistic regression analyses were used to identify the predictors of EE. Diabetes mellitus (DM), the involvement of the left or both hepatic lobes, and the adjacent vessels on the CT were significantly more frequent than those in the non-EE group (p < 0.05 in all), and they were the significant predictors of EE in the logistic regression analyses. In patients with K. pneumoniae-related PLA, the CT findings, such as the locations of the abscess (i.e., left or both lobes) and the involvement of the adjacent vessels, should be considered in addition to the ocular symptoms for an early diagnosis of EE.

Transarterial and Transvenous Approach for the Embolization of Arteriovenous Fistula between the Hepatic Arteries and Inferior Vena Cava Associated with Liver Abscess Due to Cholangitis

“…Hepatic abscesses rarely involve the portal vein or hepatic vein and cause thrombus forma-tion. However, several reports have indicated that liver abscesses caused by amoeba or Klebsiella pneumoniae more frequently involve the portal vein and hepatic vein [3][4][5]. In our case, we posit that a pseudoaneurysm caused by the liver abscess might have ruptured into the right hepatic vein or that the liver abscess invaded both the intrahepatic artery and right hepatic vein, resulting in an AVF.…”

Liver abscess in the caudate lobe caused by Klebsiella pneumoniae: a rare case report

“…Since the gastrointestinal tract and the portal vein are linked, the pathogenic bacteria that cause liver abscesses primarily begin there. Diabetes mellitus and elderly male patients are most likely to develop abscesses [7,8].Due to the right lobe receives more blood ow volume, involvement of right lobe was predominant in liver abscesses(54.7%-82.7%) (Table 1 Persistent thrombocytopenia is related with poor prognosis in Intensive Care Unit (ICU) patients [21].The patient`s platelets count is pure Alice in wonderland. The number of platelets has dropped to 6 ×10 9 /L.…”

Pyogenic liver abscess complicated with endogenous endophthalmitis caused by Klebsiella pneumoniae: A case report and Literature Review

“…13 In patients with K. pneumoniae-induced PLA, CT findings such as abscess location (i.e., left or both lobes) and involvement of adjacent vessels, in addition to ocular symptoms, should be considered for an early diagnosis of EE. 14 Treatment typically involves a combination of antibiotics and drainage of the abscess if necessary. K. pneumoniae was still highly susceptible to ceftazidime and amikacin, and the multidrug-resistant (MDR) K. pneumoniae isolates were not common in EE.…”

“…In patients with K. pneumoniae ‐induced PLA, CT findings such as abscess location (i.e., left or both lobes) and involvement of adjacent vessels, in addition to ocular symptoms, should be considered for an early diagnosis of EE 14 . Treatment typically involves a combination of antibiotics and drainage of the abscess if necessary.…”