Introduction: Invasive liver abscess syndrome is characterized by the isolation of K. pneumoniae from the abscess aspirate or blood in patients who have imaging-confirmed liver abscesses, without any preexisting hepatobiliary disease. Prostate abscesses often arise as complications of acute urinary tract infections. Instances of concurrent pyogenic liver and prostate abscesses are very rare.
Description: We present a case of a 47-year-old male who presented to our hospital with complaints of generalized malaise, right abdomen fullness with pain, nausea, vomiting, urinary frequency, nocturia, elevated lactic acid and sepsis. He was managed in ICU with empiric antibiotic and IV fluids. CT abdomen/pelvis revealed a large non-ruptured liver abscess measuring 10.1 cm*6.2 cm*10.7 cm and prostate abscess with prostatomegaly. Liver abscess was drained with CT guided catheter placement into right hepatic lobe abscess, which was continued for 2 weeks. PCR of abscess aspirate, blood culture and urine cultures confirmed K. pneumoniae, diagnosing him with invasive liver abscess syndrome. He was effectively treated with a six-week course of antibiotics.
Discussion: Invasive liver abscess syndrome is characterized by the isolation of K. pneumoniae from the abscess aspirate or blood in patients who have imaging-confirmed liver abscesses, without any preexisting hepatobiliary disease. The optimal treatment for K. pneumoniae invasive syndrome depends on the specific infection site and severity of the disease. Antibiotic therapy is the mainstay of treatment for most cases of K. pneumoniae invasive syndrome, and empirical broad-spectrum antibiotics should be initiated promptly in suspected cases. Relapse of K. pneumoniae liver abscess after adequate treatment is rare. Except for empiric antibiotic treatment, pigtail catheter drainage is the major treatment strategy for liver abscess unless multiple micro-abscess are present, in which case, fine needle aspiration is satisfactory for both diagnosis and treatment. Pigtail catheter drainage is usually continued for 1–2 weeks, and the drain is removed when culture of the liver abscess become sterile with daily drainage amount < 5 mL for several days. Oral antimicrobial treatment for 1–2 months after discharge from the hospital will consolidate the effect of treatment.
