Oka Kohei, Yamamoto Natsumi, Amano Shiho, Sano Chiaki, Ohta Ryuichi
Community Care, Unnan City Hospital, Unnan, JPN.
Community Medicine Management, Faculty of Medicine, Shimane University, Izumo, JPN.
Cureus. 2025 Jun 5;17(6):e85438. doi: 10.7759/cureus.85438. eCollection 2025 Jun.
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.
一名患有多种合并症的82岁男性因发热和活动能力下降前往一家乡村医院就诊，被诊断为高毒力肺炎克雷伯菌（HVKP）所致的肝脓肿。最初采用静脉抗生素治疗使影像学表现有所改善，但患者出现复发性菌血症、腰痛，最终发展为硬膜外脓肿、感染性心内膜炎和脑脓毒性栓子。尽管升级了抗生素治疗并给予支持治疗，但其病情仍恶化，由于严重脓毒症和心力衰竭，手术干预被认为不可行。他于住院第27天死亡。该病例凸显了HVKP感染的诊断和治疗挑战，尤其是在患有基础疾病的老年人中。即使早期治疗且原发性脓肿得到明显控制，HVKP仍可经血行播散，导致严重并发症。临床医生应高度怀疑其发生全身播散，并考虑延长治疗时间和加强监测，尤其是在老年或免疫功能低下的患者中。
