Successful combined treatment of invasive Klebsiella pneumoniae liver abscess with IVR and antibiotic therapy applied before hepatic resection

Background: Klebsiella-associated liver abscesses can progress rapidly and cause severe metastatic infections such as meningitis and hydrocephalus, which are associated with high morbidity and mortality. Rapid diagnosis followed by combined treatment of IVR and hepatic resection is necessary to improve outcomes and prevent severe secondary metastatic complications.Case presentation: An 84-year-old woman was transferred to our hospital with a large liver abscess and septic shock. Abdominal CT showed multiloculated liver abscesses 13 cm in diameter in the right lobes of the liver, with right hepatic vein involvement. We first performed liver abscess drainage with IVR, as well as treatment with intravenous administration of cefozopran. Klebsiella pneumoniae with invasive infection was confirmed by a string test; the K1 serotype with the rmpA and magA genes was determined by PCR and Sanger sequencing. Although the abscess had shrunk to a diameter of 7 cm four weeks after drainage, she had chronic inflammatory conditions with persistent viscous pus discharge from drainage tubes. Due to the reduction in the size of the abscess, right hepatic vein-preserving posterior hepatectomy using intraoperative ultrasound was performed safely. The postoperative course was uneventful and she was discharged after 18 days.Conclusion: We present a case of successful hepatic resection in a patient treated with combined treatment of IVR and antibiotic therapy before surgery for the treatment of invasive K. pneumoniae liver abscess.