Hepatosplenic Abscess From Klebsiella pneumoniae in Poorly Controlled Diabetic

Abstract

Invasive Klebsiella pneumoniae infection and pyogenic liver abscess in patients with underlying diabetes mellitus has been well described over the past 3 decades, predominantly in the Southeast Asian population, especially in Taiwan and Korea. K pneumoniae has now become the most common causative pathogen of pyogenic liver abscess in Asian countries. This shift from Escherichia coli to K pneumoniae may also be increasingly occurring in the United States of America and European countries. Compared with the >80% incidence described in Taiwan, the incidence in the United States is still reported to be lower, around 30% to 40%. However, as more evidence and reports come to light, it has become of prime importance to recognize Klebsiella as a significant emerging cause of metastatic infections in patients with uncontrolled diabetes in the United States and not just Southeast Asia, given the significant morbidity and mortality associated with the condition. In this article, we discuss the case of a 53-year-old African American female who presented with diabetic ketoacidosis and was subsequently found to have K pneumoniae pyogenic liver abscess primarily in the left hepatic lobe, bacteremia, and septic metastases to the spleen. She required extensive percutaneous drainage of abscesses and a prolonged course of multiple antibiotics. This case illustrates the growing incidence of invasive K pneumoniae infection in the diabetic population in the United States, and better patient outcomes from prompt recognition and treatment.

Splenic abscess presenting as diabetic ketoacidosis: A rare cause of DKA in Type 2 DM patient

“…Among them, Klebsiella Pneumonia has been detected to be one of the commonest organism repsonsible for hepatosplenic abscess in diabetic patients with uncontrolled blood sugars in various studies. [7,8] It is to be noted that risk of deep organ abscess increases with uncontrolled hyperglycemia thus we report here a case report of a large splenic abscess as a precipitating infection of patient presented with DKA.…”

Occult colon cancer with liver abscess and pancreatitis as the first manifestations: A case report

“…Patients with diabetes are more likely to suffer from Klebsiella pneumoniae infection, and KP-PLA patients with high blood glucose level are more likely to develop extrahepatic metastatic infections. [13,14] The generally accepted theory is that high glucose levels reduce the adhesion, chemotaxis, phagocytosis of neutrophils, and increase the aggressiveness of Klebsiella pneumoniae. [15] The most common bacterial infection of PLA originates from the biliary tract, and some cryptogenic liver abscesses with unknown infection source were reclassified as enteric after intestinal examination, even were associated with intestinal tumors.…”

Solid Organ Abscess by Melioidosis: An Emerging Infection Among Diabetics in Odisha, India

“…Diabetes was a risk factor found in both cases. Both of them had abscesses in the liver as well as spleen, which evoked a diagnostic dilemma with differential diagnoses like hydrated cyst, infective embolism in case of infective endocarditis, and abscess due to Klebsiella infection in diabetes [5], which were later ruled out with imaging and blood culture reports.…”