Department of Surgery, Maizuru Medical Center, Aza Yukinaga 2410, Maizuru, Kyoto, 6258502, Japan.
Department of Digestive surgery, Iseikai Hospital, Higashiyodogawa, Sugawara 6-2-25, Osaka, 5330022, Japan.
J Med Case Rep. 2022 Jun 7;16(1):234. doi: 10.1186/s13256-022-03325-7.
Brain abscess is a life-threatening event. Moreover, when Klebsiella pneumoniae is the cause, rapid diagnosis and appropriate treatment are required. Klebsiella invasive liver abscess syndrome, a bloodstream metastatic infection of potentially aggressive nature, has been recognized to cause infection in the central nervous system, and concern for Klebsiella liver abscess syndrome is increasing globally.
A 73-year-old Japanese woman was admitted to the institution complaining of aggravated dysarthria and weakness in the right upper extremities with onset 5 days earlier. Magnetic resonance imaging revealed a brain abscess in the left basal ganglia, and abdominal computed tomography revealed a liver abscess in liver segment 7. The patient's dysarthria symptoms became increasingly worse over the next few days, so surgical drainage via frontotemporal craniotomy was performed on admission day 3, and subsequent culture from the brain abscess showed growth of Klebsiella pneumoniae. On admission day 9, percutaneous transhepatic drainage of the liver segment 7 abscess was undertaken. The pus culture also showed growth of Klebsiella pneumoniae, thus associating the liver abscess with the brain abscess. Following long-term conservative treatment with antibiotics and abscess drainage, the liver abscess disappeared. However, the patient continuously presented with right upper quadrant pain, and abdominal computed tomography showed swelling of the gallbladder. Consequently, percutaneous transhepatic gallbladder drainage was initially administered, and the bile culture was also positive for Klebsiella pneumoniae. For radical treatment, a laparoscopic cholecystectomy was performed on admission day 99. The postoperative period was complicated by an intraabdominal abscess; however, conservative therapy was successful. She was subsequently discharged, and 12-month follow-up revealed no further sequelae.
We describe a rare case of Klebsiella liver abscess syndrome, which first presented with a central nervous system manifestation. Our patient was successfully treated via an early surgical intervention and subsequent antibiotic therapy. Although surgical drainage remains the cornerstone treatment for brain abscess, when a brain abscess is found, and there is a high index of suspicion for the existence of a liver abscess, Klebsiella liver abscess syndrome should be considered as a possible diagnosis.
脑脓肿是一种危及生命的疾病。此外，当引起感染的细菌是肺炎克雷伯菌时，需要快速诊断和适当的治疗。侵袭性肝脓肿综合征（一种具有潜在侵袭性的血流转移性感染）已被认为可导致中枢神经系统感染，全球范围内对肺炎克雷伯菌肝脓肿综合征的关注正在增加。
一名 73 岁的日本女性因 5 天前出现的加重性构音障碍和右侧上肢无力入住我院。磁共振成像显示左侧基底节脑脓肿，腹部计算机断层扫描显示肝段 7 肝脓肿。在接下来的几天里，患者的构音障碍症状逐渐加重，因此在入院第 3 天行额颞部开颅手术引流脓肿，随后从脑脓肿培养出肺炎克雷伯菌。入院第 9 天行肝段 7 脓肿经皮经肝穿刺引流。脓液培养也显示肺炎克雷伯菌生长，因此将肝脓肿与脑脓肿联系起来。在长期使用抗生素和脓肿引流的保守治疗后，肝脓肿消失。然而，患者持续出现右上腹疼痛，腹部计算机断层扫描显示胆囊肿胀。因此，首先进行经皮经肝胆囊引流，胆汁培养也呈肺炎克雷伯菌阳性。为了根治，在入院第 99 天行腹腔镜胆囊切除术。术后出现腹腔脓肿；然而，保守治疗成功。她随后出院，12 个月随访未发现进一步的后遗症。
我们描述了一例罕见的肺炎克雷伯菌肝脓肿综合征病例，该病例首先表现为中枢神经系统表现。我们的患者通过早期手术干预和随后的抗生素治疗成功治愈。虽然手术引流仍然是脑脓肿的基石治疗方法，但当发现脑脓肿且高度怀疑存在肝脓肿时，应考虑肺炎克雷伯菌肝脓肿综合征作为可能的诊断。
