title: Klebsiella pneumoniae invasive liver abscess syndrome with purulent meningitis and septic shock: A case from mainland China.
abstract: We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liver abscess, septic shock, purulent meningitis and metastatic hydrocephalus. Upon admission, the clinical manifestations, laboratory and imaging examinations were compatible with a diagnosis of K. pneumoniae primary liver abscess. Her distal metastasis infection involved meningitis and hydrocephalus, which could flare abruptly and be life threatening. Even with early adequate drainage and antibiotic therapy, the patient's condition deteriorated and she ultimately died. To the best of our knowledge, this is the first case of K. pneumoniae invasive liver abscess syndrome with septic meningitis reported in mainland China. Our findings reflect the need for a better understanding of the epidemiology, risk factors, complications, comorbid medical conditions and treatment of this disease.
authors.affiliation: Yun Qian, San-Chuan Lai, Zheng-Hua Lin, Shu-Jie Chen, Jian-Min Si, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Qian
authors.affiliation: Yun Qian, San-Chuan Lai, Zheng-Hua Lin, Shu-Jie Chen, Jian-Min Si, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: Chi-Chun
authors.initials: CC
authors.lastname: Wong
authors.affiliation: Yun Qian, San-Chuan Lai, Zheng-Hua Lin, Shu-Jie Chen, Jian-Min Si, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: San-Chuan
authors.initials: SC
authors.lastname: Lai
authors.affiliation: Yun Qian, San-Chuan Lai, Zheng-Hua Lin, Shu-Jie Chen, Jian-Min Si, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: Zheng-Hua
authors.initials: ZH
authors.lastname: Lin
authors.affiliation: Yun Qian, San-Chuan Lai, Zheng-Hua Lin, Shu-Jie Chen, Jian-Min Si, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: Wei-Liang
authors.initials: WL
authors.lastname: Zheng
authors.affiliation: Yun Qian, San-Chuan Lai, Zheng-Hua Lin, Shu-Jie Chen, Jian-Min Si, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Yun Qian, San-Chuan Lai, Zheng-Hua Lin, Shu-Jie Chen, Jian-Min Si, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: Kong-Han
authors.initials: KH
authors.lastname: Pan
authors.affiliation: Yun Qian, San-Chuan Lai, Zheng-Hua Lin, Shu-Jie Chen, Jian-Min Si, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: Shu-Jie
authors.initials: SJ
authors.lastname: Chen
authors.affiliation: Yun Qian, San-Chuan Lai, Zheng-Hua Lin, Shu-Jie Chen, Jian-Min Si, Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Si
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques; D002681:China; D018450:Disease Progression; D004322:Drainage; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity*; D008100:Liver Abscess / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D008875:Middle Aged; D012772:Shock, Septic / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Invasive liver abscess syndrome; Klebsiella pneumonia; Meningitis; Pyogenic liver abscess; Septic shock