2307 Liver Abscess Complicated by Invasive Klebsiella Syndrome Resulting in Endophthalmitis

Abstract

INTRODUCTION: Invasive Klebsiella pneumoniae Syndrome is characterized by liver abscesses, bacteremia, and metastatic infection – particularly endogenous endophthalmitis. First described in Southeast Asia in the 1980s, this syndrome has been increasingly identified in North America and is linked to virulent strains defined by hypermucoviscosity specific capsular serotypes, especially serotype K1 and K2. Following the development of a liver abscess, bile leak is a potential complication that may benefit from endoscopic management. CASE DESCRIPTION/METHODS: A 68-year-old female presented with 5 days of fevers, rigors, & chills. Blood cultures grew mucoid Klebsiella pneumonia, and a large hepatic abscess was noted on abdominal imaging. Shortly after admission, she developed left-sided visual deficits, with floaters and decreased visual acuity. She was found to have endogenous endophthalmitis and received intravitreal antibiotics. A percutaneous hepatic drain was placed, and she was treated with IV ceftriaxone. At a one-week follow-up, she reported decreased drain output and right flank pain. The drain had bilious output and was concerning for bile leak. ERCP showed a contrast leak at the level of the common bile duct, and a stent was placed. Repeat cultures were sterile, with no output following stent placement, so the drain was removed. She completed 6 weeks of antibiotics, and follow up imaging demonstrated marked improvement. She underwent vitrectomy with anterior chamber washout. Despite the resolution of abscess and bacteremia, she had no recovery of vision in the affected eye. Although the Klebsiella strain was of mucoid nature, the traditional K1 hypermucoviscosity serotype was negative. Only K1 serotype was tested for in our patient. DISCUSSION: Klebsiella pneumoniae is known to result in highly invasive community-acquired infection in immunocompetent patients without underlying hepatobiliary or intestinal disease, particularly the K1 and K2 subtypes, which are the most virulent of the known serotypes. Their capsules essentially protect the bacteria from phagocytosis. Endophthalmitis is a common complication, with high morbidity. Liver abscesses are treated with antibiotics and percutaneous drainage. Development of bilious drain output may signal the development of a bile leak, which can be successfully managed with endoscopic stenting.