Digestive and Liver Disease 41 (2009) 838

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Digestive and Liver Disease

journal homepage: www.elsevier.com/locate/dld

Image of the Month

Liver abscess caused by Klebsiella pneumoniae

F. Casella a , M.G. Manenti a , C. Conca a , V. Repetti a ,
P. Longhi a , S. Lazzaroni a , A. Mercieri a , R. Furlan a,b,
a
b

Divisione di Medicina Generale, Azienda Ospedaliera Bolognini, Seriate (Bg), Italy

Universit degli Studi di Milano, Milan, Italy

a r t i c l e

i n f o

Article history:
Received 18 August 2008
Accepted 19 August 2008
Available online 5 October 2008

Abdominal computed tomography scan showing a 10-cm diameter Klebsiella pneumoniae abscess is given. Notice the hypodense
lesion with internal septa, a distinctive feature of Klebsiella related
liver abscesses [1].
The image refers to a 29-year old Indian man who presented
with a 4-day history of fever, chills, anorexia and fatigue. An
ultrasound-guided percutaneous drainage was placed yielding
150 cm3 of purulent uid. Two out of three blood cultures grew
Klebsiella pneumoniae. The patient was given intravenous gentamicin and metronidazole leading to a clinical and radiological
improvement.
Klebsiella pneumoniae was identied in recent studies as the
most common cause of pyogenic liver abscess (PLA) in Asia and
United States [2].
Symptoms of PLA are often non-specic such as fever, fatigue
and anorexia. High fever is the most common nding at presentation (occurring in 90% of patients), while only one-half of patients
present with specic signs localized to the right upper abdominal
quadrant as abdominal pain, jaundice and hepatomegaly [2].
Klebsiella pneumoniae-associated liver abscesses have distinctive ultrasonographic and CT features [1,3]. They have
a predominantly solid ultrasonographic appearance, probably
related to their failure of liquefaction [3]. Moreover a relatively
small quantity of pus at initial aspiration was observed in Klebsiella liver abscesses [3], possibly related to their predominant solid
consistency made up of aggregation of multiple locules that do not
communicate.

References
[1] Kim SB, Je BK, Lee KY, Lee SH, Chung HH, Cha SH. Computed tomographic
differences of pyogenic liver abscesses caused by Klebsiella pneumoniae and
non-Klebsiella pneumoniae. J Comput Assist Tomogr 2007;31:5965.
[2] Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends
in etiology and mortality. Clin Infect Dis 2004;39:16549.
[3] Hui JY, Yang MK, Cho DH, Li A, Loke TK, Chan JC, et al. Pyogenic liver abscesses
caused by Klebsiella pneumoniae: US appearance and aspiration ndings. Radiology 2007;242:76976.

Corresponding author at: Medicina Generale, Osp. Bolognini, via Paderno 21,
Seriate (BG) 24068, Italy. Tel.: +39 035 3063380; fax: +39 035 3063601.
E-mail address: raffaello.furlan@unimi.it (R. Furlan).
1590-8658/$36.00 2008 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.dld.2008.08.004

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