Klebsiella pneumoniae invasive syndrome with liver, lung, and brain abscesses complicated with pulmonary fungal infection: a case report and review of the literature

Klebsiella pneumoniae invasive syndrome with liver, lung, and brain abscesses complicated with pulmonary fungal infection: a case report and review of the literature

Klebsiella pneumoniae invasion syndrome, Liver abscess, Brain abscess, Lung abscess, Pulmonary fungal
infection, Case report

Background Klebsiella pneumoniae invasion syndrome (KPIS) is a severe multi-site infection that is usually caused
by hypervirulent Klebsiella pneumoniae. The bacteria are relatively common in Asian diabetics and can cause organ

abscesses or sepsis. When patients develop intracranial infection, the prognosis is poor. After anti-infective treat-
ment, the Klebsiella pneumoniae-induced liver and lung abscesses and pulmonary fungal infection were relieved,

but the brain abscesses worsened. Such complex and severe infection cases are rarely reported. Early identification
of intracranial infection, selection of antibiotics with high concentrations in cerebrospinal fluid, and active treatment
of complications such as diabetes and fungal infection are of great significance for the prognosis of patients.
Case presentation A 71-year-old patient diagnosed with liver abscess in another hospital was transferred to our

hospital due to a worsening condition. On day 1 (day of admission), the patient was given invasive mechanical venti-
lation, continuous renal replacement therapy combined with endotoxin adsorption, antimicrobial treatment with imi-
penem-cilastatin, and percutaneous catheter drainage for liver abscess. Metagenomic next-generation sequencing

in bronchoalveolar lavage fluid indicated Klebsiella pneumoniae (K. pneumoniae), Candida albicans, and Aspergillus
flavus complex, and no viruses were detected. Blood and pus cultures revealed K. pneumoniae that was sensitive

to piperacillin/tazobactam. The anti-infection therapy was adjusted to piperacillin/tazobactam combined with vori-
conazole. On day 14, a head computed tomography (CT) scan showed no significant changes, and a chest CT scan

showed absorption of multiple abscesses in both lungs. The patient was still unconscious. After the endotracheal tube
was removed, cranial magnetic resonance imaging (MRI) showed multiple brain abscesses. Finally, his family gave up,
and the patient was discharged and died in a local hospital.
Conclusion In cases of K. pneumoniae infection, the possibility of intracranial, liver, lung, or other site infections

should be considered, and physicians should be vigilant for the occurrence of KPIS. For patients suspected of develop-
ing an intracranial infection, cerebrospinal fluid should be tested and cultured as soon as possible, a head MRI should

be performed, and antibiotics with high distribution in cerebrospinal fluid should be used early. When patients are
complicated with diabetes, in addition to glycemic control, vigilance for concurrent fungal infections is also needed.

Yunhao Luo1†, Wen Hu2†, Lingna Wu1

, Shijie Duan1 and Xingmei Zhong1*

https://doi.org/10.1186/s12245-023-00574-1

2023

Peri Irawan

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