title: Simultaneous Klebsiella pneumoniae and amoebic liver abscess in an immunocompetent patient.
abstract: Simultaneous Klebsiella pneumoniae and amoebic liver abscess is rarely reported in immunocompetent patients. A 47-year-old man was hospitalized with abdominal pain, fever, chills, and hypotension. Physical examination revealed right upper quadrant tenderness. Abdominal computed tomography showed an area of low attenuation with some liquefaction in the liver. Echo-guided aspiration revealed 30 mL of pus, which grew Klebsiella pneumoniae, and the same organism was isolated from the blood. Cytology examination of the pus showed scattered amoeba. The patient gradually improved over 1 month on treatment with cefmetazole and metronidazole, along with repeated drainage of the abscess. His amoebic indirect hemagglutination titer was 1:128, but no parasite ova or amoeba were found in the stool. He had no evidence of immunocompromise. Parasitic diseases may be a predisposing factor for bacterial infections, including pyogenic liver abscess. The possible coexistence of amoebae and bacteria in a liver abscess should not be discounted.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
authors.forename: Huan-Lin
authors.initials: HL
authors.lastname: Chen
authors.forename: Wen-Hsiung
authors.initials: WH
authors.lastname: Chang
authors.forename: Shou-Chuan
authors.initials: SC
authors.lastname: Shih
authors.forename: Shee-Chan
authors.initials: SC
authors.lastname: Lin
authors.forename: Tsang-En
authors.initials: TE
authors.lastname: Wang
authors.forename: Cheng-Hsin
authors.initials: CH
authors.lastname: Chu
authors.forename: Yu-Jan
authors.initials: YJ
authors.lastname: Chen
authors.forename: Kwok-Kuen
authors.initials: KK
authors.lastname: Pang
authors.forename: Ming-Jong
authors.initials: MJ
authors.lastname: Bair
mesh_terms: D006801:Humans; D007710:Klebsiella Infections / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D007711:Klebsiella pneumoniae; D008101:Liver Abscess, Amebic / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D008297:Male; D008875:Middle Aged