Klebsiella pneumoniae liver abscess in an adolescent with diabetes: A case report.

RATIONALE: Klebsiella pneumoniae liver abscess is a serious infectious disease that primarily affects patients with diabetes mellitus (DM). The management of Klebsiella pneumoniae liver abscess has been well documented in adults, but pediatric reports remain sparse.

PATIENT CONCERNS: A 13-year-old girl presented with a history of poorly controlled type 1 DM. She had a high fever for 1 day. Physical examination revealed hepatomegaly with tenderness but without icteric sclera or skin jaundice. Leukocytosis with left shift, elevated CRP, and hyperbilirubinemia were also observed.

DIAGNOSES: Imaging studies, including abdominal computed tomography and ultrasound, showed a liver abscess. Culture of the pus confirmed K pneumonia (KP). Abdominal ultrasound showed a 6 × 5 cm multilocular cystic lesion in liver segment 6 consistent with the diagnosis of pyogenic liver abscess.

INTERVENTIONS: The patient received intravenous ceftriaxone and metronidazole for 4 weeks, followed by 4 weeks of oral antibiotic therapy with cefixime. Ultrasound-guided percutaneous catheter aspiration was also successfully performed.

OUTCOMES: After 2 months of antibiotic treatment, the liver abscess shrank significantly, which was also confirmed by follow-up imaging.

LESSONS: This case review and literature review highlight the predominance of KP in pediatric pyogenic liver abscesses in Taiwan and the important role of diabetes in pediatric suppurative liver abscess. Children with DM are more likely to develop cryptogenic gas-producing abscesses and metastatic complications. Early diagnosis, timely intervention, and strict glycemic control are essential to improving the prognosis of this high-risk group.