Pyogenic Liver Abscess and Endogenous Endophthalmitis Due to K64-ST1764 Hypervirulent Klebsiella pneumoniae: A Case Report

Bo Zhao; Renjing Hu; Lei Gong; Xiaoyun Wang; Yingwei Zhu; Gaojue Wu

doi:10.2147/IDR.S289088

Pyogenic Liver Abscess and Endogenous Endophthalmitis Due to K64-ST1764 Hypervirulent Klebsiella pneumoniae: A Case Report

Infect Drug Resist. 2021 Jan 12:14:71-77. doi: 10.2147/IDR.S289088. eCollection 2021.

Authors

Bo Zhao^#¹, Renjing Hu^#², Lei Gong¹, Xiaoyun Wang¹, Yingwei Zhu¹, Gaojue Wu¹

Affiliations

¹ Department of Gastroenterology, The Afﬁliated Wuxi Second People's Hospital of Nanjing Medical University, Wuxi, People's Republic of China.
² Department of Clinical Laboratory, The Afﬁliated Wuxi Second People's Hospital of Nanjing Medical University, Wuxi, People's Republic of China.

^# Contributed equally.

Abstract

Rationale: Klebsiella pneumoniae (K. pneumoniae, KP) are divided into two types: classic K. pneumoniae (cKP) and hypervirulent K. pneumoniae (hvKP). hvKP causes liver abscess and metastatic infection. Here, we report one case with pyogenic liver abscess (PLA) and endogenous endophthalmitis (EE) due to a relatively rarely reported serotype of K. pneumoniae in China.

Patient concerns: An 80-year old man presented with nausea, vomiting, and epigastric discomfort for 2 weeks.

Diagnoses: PLA was identified by CT scan and abdominal ultrasound. Urgent ophthalmologic consultation was performed. B-scan ocular ultrasound was done and he was diagnosed as EE.

Interventions: Antibiotic treatment, intravitreal injection of eyes and eye drops were given. Percutaneous needle aspiration, evisceration, and drainage of the right eye were performed.

Outcomes: Cultures of the blood, the aspirated pus from the liver abscess, and the contents of the eyeball all yielded K. pneumoniae with a positive string test. The capsular serotype was K64. According to the existence of multiple virulence genes and the severe invasive clinical manifestation, this strain is regarded as a hvKp strain. Multilocus sequence typing (MLST) revealed the sequence type (ST) of this strain was K64-ST1764. Antimicrobial resistance genes, bla _NDM-1 and bla _KPC-2, were not detected in the genome. The patient lost his eyesight but his symptoms subsided. During 15 months follow-up, the result was satisfactory.

Lessons: Here, we report one case with PLA due to a relatively rarely reported serotype of K. pneumoniae in China. This K64 K. pneumoniae strain is confirmed as hvKp by multiple methods. It is noteworthy that the sequence type is K64-ST1764 instead of the commonest ST11. Moreover, this strain is not considered a K. pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) or a carbapenem-resistant K. pneumoniae (CRKP) as it is usually. Further follow-up and research are required to investigate this strain.

Keywords: antibiotic resistance; case report; hypervirulent Klebsiella pneumoniae; pyogenic liver abscess; ultrasonography guided puncture aspiration.

Publication types

Case Reports

Grants and funding

This work was supported by the National Natural Science Foundation of China No.81500467, Foundation for Key Medical Talents in Jiangsu Province No.QNRC2016151, Six Talent Peaks Project of Jiangsu Province No.WSN-220, Six One Top-notch Talent Project of Jiangsu Province No.LGY201701. The funders had no role in the study design, conduct, analysis, interpretation of study results, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.