Simultaneous Klebsiella pneumoniae and amoebic liver abscess in an immunocompetent patient

Huan-Lin Chen, Wen-Hsiung Chang, Shou-Chuan Shih, Shee-Chan Lin, Tsang-En Wang, Cheng-Hsin Chu, Yu-Jan Chen, Kwok-Kuen Pang, Ming-Jong Bair
American Journal of the Medical Sciences 2008, 335 (5): 379-81
Simultaneous Klebsiella pneumoniae and amoebic liver abscess is rarely reported in immunocompetent patients. A 47-year-old man was hospitalized with abdominal pain, fever, chills, and hypotension. Physical examination revealed right upper quadrant tenderness. Abdominal computed tomography showed an area of low attenuation with some liquefaction in the liver. Echo-guided aspiration revealed 30 mL of pus, which grew Klebsiella pneumoniae, and the same organism was isolated from the blood. Cytology examination of the pus showed scattered amoeba. The patient gradually improved over 1 month on treatment with cefmetazole and metronidazole, along with repeated drainage of the abscess. His amoebic indirect hemagglutination titer was 1:128, but no parasite ova or amoeba were found in the stool. He had no evidence of immunocompromise. Parasitic diseases may be a predisposing factor for bacterial infections, including pyogenic liver abscess. The possible coexistence of amoebae and bacteria in a liver abscess should not be discounted.

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