Motta Ramírez, Gaspar Alberto¹,²,⁴; López Lauze, Anaïs¹,³,⁵; Cerda Sánchez, Ana Paola¹,³,⁶

Language: English/Spanish [Versión en español]
References: 4
Page: 161-162
PDF size: 756.23 Kb.

ABSTRACT

80-year-old female, with current illness of involuntary weight loss. An abdominal ultrasound was performed, with an incidental finding of pneumobilia due to a history of cholecystectomy and ERCP. One month later, her general condition was exacerbated, with abdominal pain, diarrheal stools, and fever, so it was decided to admit her to the hospital and perform an abdominal CT scan (two months after the ultrasound). Physical examination revealed dehydration and pain in the right hypochondrium without peritoneal irritation. Leukocytosis and CRP 214.2 mg/L; antibiotic treatment and percutaneous puncture were started. Three days after admission, blood culture was positive for Klebsiella pneumoniae.

INTRODUCTION

Liver abscess syndrome secondary to Klebsiella pneumoniae is an emerging infectious entity, with a clinical behavior different from other infections related to this bacterium. The main risk factor is diabetes mellitus, but most patients who develop it are previously healthy.¹

The appearance of the abscess varies depending on the stage of development. In the early stage, it is an echogenic, heterogeneous semi-solid lesion with unclear boundaries and posterior acoustic enhancement. The already formed abscess generates a round fluid image, with regular or irregular contours, surrounded by a hyperechoic halo. The identification of internal echoes corresponds to necrotic debris, gas bubbles, or reflects the viscosity of the collection, and a fluid-fluid level may appear.

The ultrasonographic pattern of Klebsiella pneumoniae liver abscess features irregular borders related to partial liquefaction, containing purulent material, which is related to its solid consistency and multiple non-communicating locules (Figure 1).^2,3

On computed tomography, a single, solid or multiloculated, thin-walled lesion typically involving a single hepatic lobe is characteristic (Figure 2).³

Gas formation is an important finding in Klebsiella pneumoniae liver abscesses and is associated with higher mortality.⁴

REFERENCES

1. Carrillo-Esper R, Soto-Hernández JL, Peña-Pérez CA, Carrillo-Córdova LD, Carrillo-Córdova CA, Carrillo Córdova DM. Síndrome de absceso hepático secundario a Klebsiella pneumoniae hipermucoviscosa con involucro pulmonar. Gaceta Médica de México. 2013; 149: 102-107.

2. Cano-Narváez XA, Andrés-Soler J, Gomila-Sand B, Darocas-Garrigues L. Absceso hepático invasivo recidivante por Klebiella mucoviscidosa. Revista Española de casos clínicos de Medicina Interna. 2024. Disponible en: http://dx.doi.org/10.32818/reccmi.a9n1a11

3. Carrillo-Esper R, Díaz-Carrillo MA, Peña-Pérez CA. Síndrome de absceso hepático secundario a Klebsiella pneumoniae hipermucoviscosa. Una entidad emergente. Med Int Mex. 2013; 29: 533-536.

4. Chan KS, Chia CTW, Shelat VG. Demographics, radiological findings, and clinical outcomes of Klebsiella pneumonia vs. non-Klebsiella pneumoniae pyogenic liver abscess: a systematic review and meta-analysis with trial sequential analysis. Pathogens. 2022; 11 (9): 976.

AFFILIATIONS

¹ Hospital Angeles Pedregal. Ciudad de México, México.

² Médico radiólogo, adscrito al Departamento de Radiología e Imagen.

³ Médico residente de tercer año, del Curso de Especialización y Residencia en Radiodiagnóstico, Departamento de Radiología e Imagen.
ORCID:

⁴ 0000-0001-9449-4600

⁵ 0009-0006-8202-8657

⁶ 0000-0002-0375-9974

If you wish to consult the supplementary data for this article, please contact editorial.actamedica@saludangeles.mx

CORRESPONDENCE

Dr. Gaspar Alberto Motta Ramírez. Correo electrónico: radbody2013@yahoo.com.mx

Received: 2024-11-13. Accepted: 2025-01-13.