2500 Pyogenic Liver Abscess Due to Klebsiella ozaenae: An Unlikely Culprit

Abstract

INTRODUCTION: Pyogenic liver abscess usually occurs in the setting of peritonitis or cholangitis where seeding may occur through the portal circulation or directly through the biliary tract. Gram negative enteric organisms such as E. coli and K. pneumoniae are most commonly implicated implicated organisms, with gram positives such a Strep species occurring usually in the setting of metastatic infection. Here we describe a case of a pyogenic liver abscess, where Klebsiella ozaenae, a rare pathogen, was isolated from the patient's blood cultures. CASE DESCRIPTION/METHODS: A 42 year old gentleman presented to the emergency department with 4 days of severe diffuse abdominal pain and fevers. He was seen 1 day prior in an outside hospital and was discharged from the emergency department. However, he was called the next morning and told that he was growing bacteria in his blood and was told to present to the nearest hospital. On presentation, vital signs revealed a fever of 103 degrees F, heart rate 109, blood pressure 120/70 mmHg. The patient was toxic appearing and had diffuse abdominal tenderness. Laboratory studies were notable for a white cell count of 14.2 k/uL. Serum chemistry and liver function tests were normal. Abdominal CT revealed a mildly lobulated low density lesion in the right hepatic lobe measuring 2.0 by 2.3 cm, with a smaller lesion measuring 0.7 cm and mild surrounding edema. The patient was started on ceftriaxone and metronidazole for coverage of pyogenic liver abscess. The larger lesion was successfully drained by the interventional radiology service, with a favorable clinical response. Two blood culture bottles from the outside hospital grew Klebsiella ozaenae. After initial improvement, patient was discharged home with 4 week course of oral ciprofloxacin and metronidazole and was stable upon follow-up. DISCUSSION: Klebsiella ozaenae is a rare cause of infection and bacteremia. It is thought to be a colonizer of the nasopharynx and and is typically associated with chronic atrophic rhinitis. To our knowledge, there has only been one previous case reported of K. ozaenae associated pyogenic liver abscess. Risk factors for bacteremia with K. ozaenae include elderly age, alcohol use, antibiotic exposure, immunosuppression, malignancy and rhinitis. Aminoglycosides, third generation cephalosporins and fluoroquinolones are considered to be drugs of choice for this organism. Clinicians should be aware of K. ozaenae and its potential to cause bacteremia and pyogenic liver abscess.