Detroit Medical Center/Wayne State University Detroit, MI
Raya Abu Tawileh, MD1, Abdallah Kheshman, MD, MPH1, Nur Saleh, MD1, Majd Khadra, MD1, Deema Almansour, DO, MS2, Muhammad Shareef, MD3 1Wayne State University School of Medicine / Detroit Medical Center, Detroit, MI; 2Detroit Medical Center/Wayne State University, Detroit, MI; 3Wayne State University School of Medicine / Detroit Medical Center, Canton, MI Introduction: Klebsiella pneumoniae primary liver abscesses (KLA) are predominantly reported in immunocompromised patients, particularly in Southeast Asia. However, cases in immunocompetent individuals are becoming increasingly recognized, even in non-endemic areas such as the United States. This case of a 40-year-old male immigrant from Mauritania underscores the importance of considering KLA in febrile patients, even in the absence of traditional risk factors.
Case Description/
Methods: A 40-year-old male without significant past medical history presented with a 4-day history of fevers and fatigue. He had been residing in Michigan for 5 months and reported occasional consumption of unclean tap water. He denied any alcohol, tobacco, illicit drug use, recent antibiotics, or weight loss. On admission, the patient was febrile and tachycardic. Laboratory studies were remarkable for leukopenia (WBC 2.1 K/µL), elevated liver enzymes (AST 125 U/L, ALT 100 U/L), and a lactic acidosis of 2.3 mmol/L. HbA1c was within normal limits. Stool studies, amoebic serologies and viral hepatitis serologies were negative. HIV-1/HIV-2 were non-reactive. CT scan of the abdomen with contrast revealed a large, gas-containing lesion in the right hepatic lobe. MRCP demonstrated a 5.3 x 3.3 x 4.1 cm non-enhancing lesion. Subsequently, patient was started on empiric antibiotics with ceftriaxone and metronidazole, and a CT-guided abscess drainage was performed. Blood and abscess cultures grew Klebsiella pneumoniae, susceptible to cephalosporins. Colonoscopy was performed revealing unremarkable results. Lung and brain imaging were negative for metastatic complications. The patient showed marked clinical improvement with antibiotics. Follow-up appointments with hepatology and infectious diseases were scheduled. Discussion: This case highlights the importance of maintaining a broad differential when evaluating febrile patients with abnormal liver function tests. Klebsiella pneumoniae primary liver abscesses are more commonly seen in immunocompromised individuals, including those with diabetes and chronic liver disease. This case is unusual because the patient is immunocompetent and lacked typical risk factors for KLA, such as diabetes or alcoholism. KLA is often monomicrobial and can lead to metastatic infections, including septic emboli to the lungs or brain. Therefore, early imaging and initiating appropriate antibiotics in a timely manner are crucial in preventing complications and ensuring a favorable outcome.
Disclosures: Raya Abu Tawileh indicated no relevant financial relationships. Abdallah Kheshman indicated no relevant financial relationships. Nur Saleh indicated no relevant financial relationships. Majd Khadra indicated no relevant financial relationships. Deema Almansour indicated no relevant financial relationships. Muhammad Shareef indicated no relevant financial relationships.
Raya Abu Tawileh, MD1, Abdallah Kheshman, MD, MPH1, Nur Saleh, MD1, Majd Khadra, MD1, Deema Almansour, DO, MS2, Muhammad Shareef, MD3. P3897 - An Unusual Presentation of <i>Klebsiella</i> Pneumoniae Primary Hepatic Abscess in an Immunocompetent Immigrant, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
