The formation of liver abscess caused by bacteria called Klebsiella pneumoniae can be life-threatening in patients with primary sclerosing cholangitis (PSC), a condition very similar to primary biliary cholangitis (PBC), according to a recent case report.
PBC and PSC are the two major types of chronic cholestatic liver disease. The main difference between the two conditions is that PBC mainly affects the bile ducts inside the liver, while PSC affects the ducts both inside and outside the liver.
The study authors reported the case of a 67-year-old female patient with PSC who developed a liver abscess caused by hyperviscous K pneumoniae. An abscess is a localized collection of pus most commonly caused by bacteria.
Read more about PBC comorbidities
The patient had previously undergone a surgical procedure to remove the head of the pancreas and the first part of the small intestine, called pancreaticoduodenectomy. After the operation, she experienced frequent inflammation of the bile ducts caused by bacteria, also known as bacterial cholangitis.
This time, the patient presented with a fever and was diagnosed with a liver abscess and bacterial cholangitis. She was admitted to a local hospital and administered meropenem intravenously. This treatment provided little benefit.
After the abscess was drained, K pneumoniae with a positive string test was identified in the pus as well as the patient’s blood. The string test is used to detect a hyperviscous strain of K pneumoniae that can cause severe infections.
The patient was quickly started on intravenous cefepime and metronidazole, but the liver abscess was only reduced in size. The patient’s overall condition gradually worsened and she passed away after 45 days of illness.
“We believe that there are three reasons why this case’s condition became serious. First, K pneumoniae was hyperviscous; second, it was post-pancreaticoduodenectomy; and finally, PSC coexisted. The combination of these things makes this case difficult to treat and is also what makes this case unique,” the authors wrote.
“The condition could have been improved by draining the abscess earlier…In such cases, pus should be collected as soon as possible to identify the causative bacteria.”
