Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Immun Inflamm Dis. 2023 Jul;11(7):e943. doi: 10.1002/iid3.943.
Pyogenic liver abscess (PLA) is a common surgical infectious disease caused by various pathogens. Klebsiella pneumoniae is a relatively recent cause, often affecting patients with low immunity. Endogenous endophthalmitis (EE), a rare and serious complication of PLA, may appear with eye symptoms before PLA. By reviewing a case of Klebsiella pneumoniae-induced PLA complicated with EE, we want to summarize the information about the characteristics, causes, and complications of PLA based on the literature review.
This case report describes a 37-year-old male who had fever high to 39°C for 10 days experienced blurred vision followed by nonlight perception vision. He reported a history of diabetes irregularly taking oral medications and insulin therapy. Imaging examination found a large low-density area in the right lobe of the liver with an unclear border and vague surrounding fat gap. The blood culture was not positive. The culture of the drainage fluid from the liver puncture showed Klebsiella pneumonia. Blood and liver puncture drainage fluid were sent for microbial high-throughput gene detection with next-generation sequencing technology (NGS), which confirmed the diagnosis of Klebsiella pneumoniae-induced PLA complicated with EE.
The patient's surgical incision had healed well at discharge, and he could feel light at his left eye. But the patient was lost to follow-up since the third month after discharge.
By reviewing this case and summarize the information about the characteristics, causes, and complications of PLA based on the literature review, we concluded that it is necessary to promptly perform liver puncture drainage and empirically use antibiotics for patients with PLA, especially those with poor glycemic control, to avoid serious complications such as EE.
化脓性肝脓肿（PLA）是一种常见的外科感染性疾病，由各种病原体引起。肺炎克雷伯菌是一种相对较新的病因，常影响免疫功能低下的患者。内源性眼内炎（EE）是 PLA 的一种罕见且严重的并发症，可能在 PLA 出现眼部症状之前出现。通过回顾一例肺炎克雷伯菌引起的 PLA 合并 EE 的病例，我们希望根据文献复习总结 PLA 的特征、病因和并发症信息。
本病例报告描述了一位 37 岁男性，发热高达 39°C 持续 10 天，出现视力模糊，随后左眼无光感。他自述患有糖尿病，不规则服用口服药物和胰岛素治疗。影像学检查发现右肝叶有一个大的低密度区，边界不清，周围脂肪间隙模糊。血培养为阴性。肝穿刺引流液培养出肺炎克雷伯菌。将血和肝穿刺引流液送检微生物高通量基因检测，采用下一代测序技术（NGS），明确诊断为肺炎克雷伯菌引起的 PLA 合并 EE。
患者出院时手术切口愈合良好，左眼能感觉到光。但患者自出院后第三个月起就失去了随访。
通过回顾该病例并结合文献复习总结 PLA 的特征、病因和并发症信息，我们得出结论，对于 PLA 患者，特别是血糖控制不佳的患者，及时进行肝穿刺引流和经验性使用抗生素非常重要，以避免 EE 等严重并发症的发生。
