{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T10:31:13Z","timestamp":1763202673226,"version":"build-2065373602"},"reference-count":22,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T00:00:00Z","timestamp":1665705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Korea Centers for Disease Control and Prevention","award":["2019-ER5501-00"],"award-info":[{"award-number":["2019-ER5501-00"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>An immunocompetent 49-year-old man presented with swelling and pain in the lower region of his left leg that had lasted for 4 weeks. The diagnosis was severe pyomyositis and osteomyelitis in the lower left leg caused by hypervirulent Klebsiella pneumoniae (hvKP) along with multiple metastatic infections in the kidneys, lungs, and brain originating from an anorectal abscess. A virulence-gene analysis revealed that the isolated K. pneumoniae harbored rmpA, entB, ybtS, kfu, iutA, mrkD, and allS-virulence genes and belonged to the K1 capsular serotype. After repeated abscess drainage procedures, intravenous ceftriaxone was administered for more than 10 weeks, and the patient\u2019s infection was controlled. We focused on the clinical features of hvKP originating from an anorectal abscess without a pyogenic liver abscess. We suggest that hvKP be considered a causative pathogen of pyomyositis and osteomyelitis resulting in multiple metastatic infections in an immunocompetent patient, and more information on the unexpected multiple metastatic infections should be obtained from a virulence analysis of K. pneumoniae.<\/jats:p>","DOI":"10.3390\/medicina58101450","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T02:29:46Z","timestamp":1665973786000},"page":"1450","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Invasive Hypervirulent Klebsiella pneumoniae Syndrome Originating from an Anorectal Abscess as Opposed to a Pyogenic Liver Abscess"],"prefix":"10.3390","volume":"58","author":[{"given":"Kum Ju","family":"Chae","sequence":"first","affiliation":[{"name":"Department of Radiology, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea"},{"name":"Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaehyeon","family":"Lee","sequence":"additional","affiliation":[{"name":"Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea"},{"name":"Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8616-3411","authenticated-orcid":false,"given":"Joo-Hee","family":"Hwang","sequence":"additional","affiliation":[{"name":"Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea"},{"name":"Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeong-Hwan","family":"Hwang","sequence":"additional","affiliation":[{"name":"Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea"},{"name":"Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/cid\/ciu444","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1136\/pgmj.2003.009274","article-title":"Tropical pyomyositis (myositis tropicans): Current perspective","volume":"80","author":"Chauhan","year":"2004","journal-title":"Postgrad. Med. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1007\/s100960100556","article-title":"Two cases of pyomyositis caused by Klebsiella pneumoniae and review of the literature","volume":"20","author":"Wang","year":"2001","journal-title":"Eur J. Clin. Microbiol. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1093\/clind\/15.4.668","article-title":"Pyomyositis in North America: Case reports and review","volume":"15","author":"Christin","year":"1992","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"107","DOI":"10.4161\/viru.22718","article-title":"Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: A new and dangerous breed","volume":"4","author":"Shon","year":"2013","journal-title":"Virulence"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1001\/archinte.1986.00360220057011","article-title":"Klebsiella pneumoniae liver abscess associated with septic endophthalmitis","volume":"146","author":"Liu","year":"1986","journal-title":"Arch. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1128\/MMBR.00078-15","article-title":"Klebsiella pneumoniae: Going on the Offense with a Strong Defense","volume":"80","author":"Paczosa","year":"2016","journal-title":"Microbiol. Mol. Biol. Rev. MMBR"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4377","DOI":"10.1128\/JCM.02316-14","article-title":"Multiplex PCR for detection of seven virulence factors and K1\/K2 capsular serotypes of Klebsiella pneumoniae","volume":"52","author":"Compain","year":"2014","journal-title":"J. Clin. Microbiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5379","DOI":"10.1128\/AAC.02523-14","article-title":"Clinical and molecular characteristics of emerging hypervirulent Klebsiella pneumoniae bloodstream infections in mainland China","volume":"58","author":"Liu","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1086\/519262","article-title":"Klebsiella pneumoniae genotype K1: An emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess","volume":"45","author":"Fang","year":"2007","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_11","first-page":"90","article-title":"Peculiar purulence: Hypervirulent Klebsiella pneumoniae causing pyomyositis","volume":"65","author":"Mgbemena","year":"2017","journal-title":"Int. J. Infect. Dis. IJID Off. Publ. Int. Soc. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e157-60","DOI":"10.1016\/j.jinf.2006.09.011","article-title":"Internal obturator muscle abscess caused by Klebsiella pneumoniae","volume":"54","author":"Yahalom","year":"2007","journal-title":"J. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1007\/s10096-017-3160-z","article-title":"Risk factors and clinical outcomes of hypervirulent Klebsiella pneumoniae induced bloodstream infections","volume":"37","author":"Li","year":"2018","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis. Off. Publ. Eur. Soc. Clin. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"229","DOI":"10.3389\/fpubh.2019.00229","article-title":"An Outbreak of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Wenzhou, China","volume":"7","author":"Zhao","year":"2019","journal-title":"Front. Public Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e190","DOI":"10.1016\/S1473-3099(16)30021-4","article-title":"Primary osteomyelitis caused by hypervirulent Klebsiella pneumoniae","volume":"16","author":"Prokesch","year":"2016","journal-title":"Lancet. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.jiac.2019.06.001","article-title":"Molecular analysis of virulence factors of hypermucoviscous Klebsiella pneumoniae in a diabetes patient with multifocal intramuscular and musculoskeletal abscesses","volume":"26","author":"Kudo","year":"2020","journal-title":"J. Infect. Chemother. Off. J. Jpn. Soc. Chemother."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1080\/21505594.2017.1317412","article-title":"Hypervirulence and hypermucoviscosity: Two different but complementary Klebsiella spp. phenotypes?","volume":"8","year":"2017","journal-title":"Virulence"},{"key":"ref_18","doi-asserted-by":"crossref","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":"ref_19","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1007\/s10096-011-1334-7","article-title":"Fecal carriage of serotype K1 Klebsiella pneumoniae ST23 strains closely related to liver abscess isolates in Koreans living in Korea","volume":"31","author":"Chung","year":"2012","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Lin, Y.-T., Siu, L.K., Lin, J.-C., Chen, T.-L., Tseng, C.-P., Yeh, K.-M., Chang, F.-Y., and Fung, C.-P. (2012). Seroepidemiology of Klebsiella pneumoniae colonizing the intestinal tract of healthy chinese and overseas chinese adults in Asian countries. BMC Microbiol., 12.","DOI":"10.1186\/1471-2180-12-13"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2354","DOI":"10.1128\/JCM.00034-11","article-title":"Familial Spread of a Virulent Clone of Klebsiella pneumoniae Causing Primary Liver Abscess","volume":"49","author":"Harada","year":"2011","journal-title":"J. Clin. Microbiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1007\/s10096-011-1396-6","article-title":"Clinical and phenotypic differences between classic and hypervirulent Klebsiella pneumonia: An emerging and under-recognized pathogenic variant","volume":"31","author":"Pomakova","year":"2012","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/10\/1450\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:53:47Z","timestamp":1760144027000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/10\/1450"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,14]]},"references-count":22,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["medicina58101450"],"URL":"https:\/\/doi.org\/10.3390\/medicina58101450","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2022,10,14]]}}}