Incidental detection of hypervirulent klebsiella pneumoniae liver abscess with systemic and cardiac complications in an elderly diabetic woman.

Hypervirulent Klebsiella pneumoniae (HvKp) is an emerging pathogen causing severe community-acquired infections, especially in diabetic patients, often with atypical presentations. We report a 63-year-old diabetic woman presenting with shoulder pain, in whom point-of-care ultrasound (POCUS) incidentally detected a pyogenic liver abscess; contrast-enhanced computed tomography confirmed impending rupture. Cultures identified a hypervirulent strain (positive string test, polymerase chain reaction confirmed iucA, rmpA, and peg-344), triggering severe systemic inflammation (CRP-274.9 mg/L, procalcitonin-10.43 mcg/L), respiratory failure, non-ST-elevation myocardial infarction (NSTEMI), and Takotsubo cardiomyopathy, despite antimicrobial sensitivity. Successful management included percutaneous drainage, escalation of antibiotics to meropenem, and cardiovascular support, resolving the infection by day 14. This case underscores POCUS's role in detecting occult abscesses in high-risk diabetics, the link between hyperglycaemia and HvKp virulence, and the potential for HvKp-induced inflammation to precipitate cardiac complications, necessitating multidisciplinary care. The string test remains a pragmatic diagnostic tool in resource-limited settings, while early recognition, source control, and tailored therapy are critical to reducing morbidity and mortality in HvKp infections.