{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:13:55Z","timestamp":1789452835097,"version":"build-2803163510"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    Invasive\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    liver abscess syndrome (IKLAS) is a severe condition characterized by liver abscesses with systemic complications, often caused by hypervirulent strains. We present a 65-year-old woman with no predisposing factors who developed IKLAS complicated by septic pulmonary embolism and polymicrobial co-infections. The patient presented with a one-month history of right upper abdominal pain, fever (39.5\u00b0C), and respiratory distress. Initial laboratory findings revealed leukocytosis (WBC 15.97\u202fG\/L), elevated inflammatory markers (CRP 83.04\u202fmg\/dL, PCT 96.9\u202fng\/mL), and hepatic dysfunction (ALT 361.7\u202fU\/L, AST 573.9\u202fU\/L). Imaging identified a massive liver abscess (153.7\u202f\u00d7\u202f112.6\u202fmm) and septic pulmonary emboli. Blood and pus cultures confirmed\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    (susceptible to imipenem\/cefoperazone-sulbactam), prompting targeted therapy. Despite initial drainage and antibiotics, her condition deteriorated due to secondary hospital-acquired infections with\n                    <jats:italic>Acinetobacter baumannii<\/jats:italic>\n                    -calcoaceticus complex and Pichia ommerica, necessitating escalation to meropenem and voriconazole. This adjustment led to clinical resolution, with abscess reduction to 74.0\u202f\u00d7\u202f46.0\u202fmm on follow-up imaging and normalization of laboratory parameters. The patient was discharged after completing antimicrobial therapy. This case underscores three critical lessons: IKLAS requires high suspicion in atypical presentations (e.g., isolated abdominal pain), as delays risk metastatic complications; polymicrobial infections may emerge secondary to invasive procedures, necessitating repeated microbiological evaluation; and large abscesses (&amp;gt;100\u202fmm) often demand prolonged, tailored therapy and multidisciplinary management. Our findings highlight the importance of early imaging, comprehensive pathogen identification, and adaptive treatment strategies to improve outcomes in this complex syndrome.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2025.1643389","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T04:10:31Z","timestamp":1755144631000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case report: Invasive Klebsiella pneumoniae liver abscess syndrome"],"prefix":"10.3389","volume":"12","author":[{"given":"Yiwei","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miao","family":"Dai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meixian","family":"Lei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e21537","DOI":"10.1016\/j.heliyon.2023.e21537","article-title":"Pyogenic liver abscess associated with Klebsiella oxytoca: mimicking invasive liver abscess syndrome","volume":"9","author":"Iwadare","year":"2023","journal-title":"Heliyon"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1513831","DOI":"10.3389\/fmed.2024.1513831","article-title":"Case report: trauma-induced Klebsiella pneumoniae invasive syndrome presenting with liver abscess, lung abscess, endophthalmitis, and purulent meningitis","volume":"11","author":"Chen","year":"2024","journal-title":"Front Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s12879-020-05702-3","article-title":"Klebsiella pneumoniae-related invasive liver abscess syndrome complicated by purulent meningitis: a review of the literature and description of three cases","volume":"21","author":"Sun","year":"2021","journal-title":"BMC Infect Dis"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1186\/s12879-023-08383-w","article-title":"Klebsiella pneumoniae invasive syndrome with liver abscess and purulent meningitis presenting as acute hemiplegia: a case report","volume":"23","author":"Chang","year":"2023","journal-title":"BMC Infect Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1007\/s12328-020-01161-0","article-title":"Invasive liver abscess syndrome accompanied by spondylodiscitis: a case report and review of the literature","volume":"13","author":"Wakabayashi","year":"2020","journal-title":"Clin J Gastroenterol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e939322","DOI":"10.12659\/AJCR.939322","article-title":"Cryptogenic Hypervirulent Klebsiella pneumoniae pyogenic liver abscess: a case report","volume":"24","author":"Leigh","year":"2023","journal-title":"Am J Case Rep"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1016\/S1473-3099(12)70205-0","article-title":"Klebsiella pneumoniae liver abscess: a new invasive syndrome","volume":"12","author":"Siu","year":"2012","journal-title":"Lancet Infect Dis"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1111\/j.1572-0241.2005.40310.x","article-title":"Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics","volume":"100","author":"Lederman","year":"2005","journal-title":"Am J Gastroenterol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"100432","DOI":"10.1016\/j.ijmmb.2023.100432","article-title":"Introducing the new face of CLSI M100 in 2023: an explanatory review","volume":"46","author":"Rai","year":"2023","journal-title":"Indian J Med Microbiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"E2","DOI":"10.1055\/a-1471-6907","article-title":"Klebsiella Pneumoniae liver abscess syndrome - a challenge for contrast-enhanced ultrasound","volume":"7","author":"Bielow","year":"2021","journal-title":"Ultrasound Int Open"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1016\/j.pathol.2023.07.007","article-title":"Coexistence of c-rmpA with p-rmpA and p-rmpA2 rather than excessive siderophores confers higher virulence in K1 Klebsiella pneumoniae","volume":"55","author":"Hu","year":"2023","journal-title":"Pathology"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e32592","DOI":"10.1097\/MD.0000000000032592","article-title":"A typical multisite invasive infection caused by hvKP: a case report and literature review","volume":"101","author":"Liu","year":"2022","journal-title":"Medicine"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/j.cmi.2020.05.012","article-title":"Detection of multiple hypervirulent Klebsiella pneumoniae strains in a new York City hospital through screening of virulence genes","volume":"27","author":"Parrott","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2257","DOI":"10.1016\/S0140-6736(24)00737-2","article-title":"Invasive liver abscess syndrome with central nervous system involvement caused by hypermucoviscous Klebsiella pneumoniae: positive string test","volume":"403","author":"de Oliveira Franco","year":"2024","journal-title":"Lancet"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"372","DOI":"10.14309\/ajg.0000000000001610","article-title":"Klebsiella pneumoniae invasive syndrome with Ventriculitis","volume":"117","author":"Lee","year":"2022","journal-title":"Am J Gastroenterol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"3000605221084881","DOI":"10.1177\/03000605221084881","article-title":"Klebsiella pneumoniae invasion syndrome: a case of liver abscess combined with lung abscess, endophthalmitis, and brain abscess","volume":"50","author":"Zhang","year":"2022","journal-title":"J Int Med Res"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1186\/s12245-023-00574-1","article-title":"Klebsiella pneumoniae invasive syndrome with liver, lung, and brain abscesses complicated with pulmonary fungal infection: a case report and review of the literature","volume":"16","author":"Luo","year":"2023","journal-title":"Int J Emerg Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1007\/BF01889042","article-title":"Hepatic abscess: sensitivity of imaging tests and clinical findings","volume":"13","author":"Halvorsen","year":"1988","journal-title":"Gastrointest Radiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1936","DOI":"10.4254\/wjh.v13.i12.1936","article-title":"Imaging evaluation of the liver in oncology patients: a comparison of techniques","volume":"13","author":"Freitas","year":"2021","journal-title":"World J Hepatol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1510","DOI":"10.3390\/microorganisms9071510","article-title":"How to handle CT-guided abscess drainages in microbiological analyses? Sterile vials vs blood culture bottles for transport and processing","volume":"9","author":"Skusa","year":"2021","journal-title":"Microorganisms"},{"key":"ref21","first-page":"273","article-title":"Expert consensus on emergency diagnosis and treatment of bacterial liver abscess","volume":"31","author":"Branch","year":"2022","journal-title":"Chin J Emerg Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1643389\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T04:10:37Z","timestamp":1755144637000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1643389\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,14]]},"references-count":21,"alternative-id":["10.3389\/fmed.2025.1643389"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1643389","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,14]]},"article-number":"1643389"}}