{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:49:53Z","timestamp":1791352193305,"version":"4.3.1"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"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:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      is a common Gram-negative pathogen in biliary tract infections and may cause deep-seated infection following bacteremia, although vertebral involvement is uncommon. Severe biliary infection and stone disease may also complicate the recognition of coexisting hepatic malignancy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 51-year-old woman presented with calculous acute obstructive suppurative cholangitis complicated by septic shock and multiorgan dysfunction. Blood and bile cultures yielded\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      , and her condition improved after urgent biliary drainage and antimicrobial therapy. During a subsequent admission, she developed progressive low-back pain. Lumbar magnetic resonance imaging showed abnormalities involving the L3\/4 vertebrae and adjacent paravertebral tissues, initially raising suspicion of spinal tuberculosis. Vertebral biopsy demonstrated focal suppurative inflammation, and metagenomic next-generation sequencing of the same tissue detected 33,735\u2005\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      -specific reads, with a relative abundance of 82.18% and genome coverage of 59.7%, together with multiple hypervirulence-associated determinants. These findings supported a diagnosis of\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      -associated pyogenic spondylitis. Meanwhile, serial hepatobiliary imaging showed regression of the right hepatic abnormalities as the infection improved, whereas a focal lesion in the left liver persisted. Subsequent imaging raised suspicion of cholangiocarcinoma, and histopathologic examination after surgical resection confirmed poorly differentiated intrahepatic cholangiocarcinoma.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case underscores the importance of maintaining diagnostic vigilance even after an initial diagnosis has been established. New focal symptoms or abnormalities that persist or follow a different clinical course should not be automatically attributed to the original disease process, and the possibility of additional coexisting diagnoses should remain under consideration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1967835","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:49:44Z","timestamp":1791348584000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Klebsiella pneumoniae-associated pyogenic spondylitis and occult intrahepatic cholangiocarcinoma during calculous cholangitis"],"prefix":"10.3389","volume":"13","author":[{"given":"Zheng","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, The Second People\u2019s Hospital of Quzhou","place":["Quzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhe","family":"Yan","sequence":"additional","affiliation":[{"name":"Graduate School of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Wangdian People\u2019s Hospital","place":["Jiaxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, The Second People\u2019s Hospital of Quzhou","place":["Quzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyi","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, The Second People\u2019s Hospital of Quzhou","place":["Quzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s00534-006-1152-y","article-title":"Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: tokyo guidelines","volume":"14","author":"Kimura","year":"2007","journal-title":"J Hepatobiliary Pancreat Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1002\/jhbp.509","article-title":"Tokyo guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis","volume":"25","author":"Miura","year":"2018","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1055\/a-1790-1314","article-title":"Microbiology of bile aspirates obtained at ERCP in patients with suspected acute cholangitis","volume":"54","author":"Gromski","year":"2022","journal-title":"Endoscopy"},{"key":"B4","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1186\/s12879-022-07785-6","article-title":"Pyogenic spondylitis caused by klebsiella pneumoniae: should the possibility of hypervirulent klebsiella pneumoniae be considered?","volume":"22","author":"Hwang","year":"2022","journal-title":"BMC Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"373","DOI":"10.5009\/gnl18339","article-title":"Natural course and risk of cholangiocarcinoma in patients with recurrent pyogenic cholangitis: a retrospective cohort study","volume":"13","author":"You","year":"2019","journal-title":"Gut Liver"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1111\/jgh.14010","article-title":"Pyogenic liver abscess related to intrahepatic bile duct stones: difficulties in infectious control and diagnosis of concomitant cholangiocarcinoma","volume":"33","author":"Feng","year":"2018","journal-title":"J Gastroenterol Hepatol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1002\/bjs.1800840717","article-title":"Hepatolithiasis associated with cholangiocarcinoma","volume":"84","author":"Su","year":"1997","journal-title":"Br J Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"115","DOI":"10.7326\/0003-4819-142-2-200501180-00010","article-title":"Improving patient care. 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