Rare Case of Klebsiella Pneumoniae Liver Abscess Complicated with Infective Endocarditis and Aortic Root Abscess in a Patient Without Diabetes

非糖尿病患罹患肺炎克雷伯氏菌肝膿瘍併發感染性心內膜炎及主動脈根膿瘍

Tien-Lung Po(栢添瀧) ； Yu-Min Lin(林裕民) ； Ming-Jen Lu(呂明仁) ； Jer-Young Liou(劉哲仰)

《內科學誌》 34卷1期 (2023/02) Pp. 50-56

https://doi.org/10.6314/JIMT.202302_34(1).08

摘要

Liver abscesses are common in Taiwan. Although Gram-negative Klebsiella species are the most common pathogens associated with liver abscesses, cases of liver abscess with infective endocarditis (IE) are rare. Herein, we report the case of a liver abscess caused by Klebsiella pneumoniae in a patient who presented with consciousness disturbance after 7 weeks of antibiotic treatment. In conjunction with the brain magnetic resonance imaging findings, cerebrospinal fluid analysis revealed septic emboli. Large aortic valve vegetation, which was not initially evident, was identified during follow-up transthoracic echocardiography and later progressed into aortic root abscess formation. Therefore, the patient received porcine aortic valve replacement, from which he recovered well. We highlight the importance of prompt detection of concomitant IE, particularly in patients with degenerative aortic valves.

關鍵字

Aortic root abscess ； Infective endocarditis ； Klebsiella pneumoniae ； Liver abscess ； Transthoracic echocardiography

並列摘要

格蘭氏陰性菌種肺炎克雷伯氏菌是台灣地區引發肝膿瘍最常見的病原體，然而鮮少有案例導致感染性心內膜炎。我們於此提出一罕見病例，肇因於肺炎克雷伯氏菌肝膿瘍之非糖尿病患，雖經過7個星期的抗生素藥物治療，卻在後續病情追蹤時發生意識改變。腦部核磁共振影像與腦脊髓液穿刺檢驗顯示感染敗血性血栓。並經由連續追蹤胸前心臟超音波掃描，確認併發感染性心內膜炎及主動脈根膿瘍，病患於後續接受主動脈根膿瘍清創手術。因此，對於具有退化性心臟瓣膜的病患，格蘭氏陰性菌種導致的肝膿瘍敗血症仍不可輕忽其惡化擴展為感染性心內膜炎的機率。