Recurrent Dissemination Despite Local Control in a Case of Hypervirulent Klebsiella pneumoniae Liver Abscess: A Case Report.

An 82-year-old man with multiple comorbidities presented to a rural hospital with fever and reduced mobility and was diagnosed with a liver abscess due to hypervirulent  (HVKP). Initial treatment with intravenous antibiotics led to radiological improvement, but the patient experienced recurrent bacteremia, low back pain, and eventually developed an epidural abscess, infectious endocarditis, and cerebral septic emboli. Despite antibiotic escalation and supportive care, his condition deteriorated, and surgical intervention was deemed unfeasible due to advanced sepsis and heart failure. He died on hospital day 27. This case highlights the diagnostic and therapeutic challenges of HVKP infections, especially in older adults with underlying illnesses. Even with early treatment and apparent control of the primary abscess, HVKP can disseminate hematogenously, leading to severe complications. Clinicians should maintain a high index of suspicion for systemic spread and consider prolonged treatment and closer monitoring, particularly in elderly or immunocompromised patients.