Invasive liver abscess syndrome accompanied by spondylodiscitis: a case report and review of the literature
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CASE REPORT
Invasive liver abscess syndrome accompanied by spondylodiscitis: a case report and review of the literature Shun‑ichi Wakabayashi1,2 · Takefumi Kimura2,3 · Naoki Tanaka4,5 · Jonathan Pham3 · Tomoyuki Tanaka1 · Shohei Higuchi6 · Junichi Kobayashi1 · Takeji Umemura2 · Akihiro Iijima1 Received: 1 April 2020 / Accepted: 14 June 2020 © This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2020
Abstract A 65-year-old man who had diabetes mellitus was referred to our hospital due to fever and back pain. Laboratory findings showed liver dysfunction and C-reactive protein (CRP) elevation. Enhanced computed tomography (CT) showed multiple liver abscesses, hepatic vein and inferior vena cava thrombosis, and spondylodiscitis in the fourth lumbar vertebrae. Based on several detections of Klebsiella pneumoniae (K. pneumoniae) in blood culture, he was diagnosed as having invasive liver abscess syndrome (ILAS), which is characterized by liver abscess and metastatic infection caused by K. pneumoniae. Despite the prompt improvement of liver abscess and thrombosis, after administering antibiotics and anticoagulant, spondylodiscitis worsened. Additionally, iliopsoas abscess emerged on repeated CT imaging. Lumbar laminectomy was needed as a radical treatment. We reviewed 12 cases of ILAS representing spondylodiscitis, and surgical treatments for spondylodiscitis were required in 7 of these cases (58%). When encountering patients with liver abscess and spondylodiscitis, we should consider the possibility of invasive disseminated K. pneumoniae infection, which is hard to treat with antibiotics alone and sometimes requires surgical treatments for spondylodiscitis. Keywords Invasive liver abscess syndrome · Klebsiella pneumoniae · Liver abscess · Spondylitis · Spondylodiscitis
Introduction
* Takefumi Kimura [email protected]; [email protected] 1
Department of Internal Medicine, Nagano Prefectural Kiso Hospital, Kiso, Japan
2
Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
3
Present Address: Molecular Signaling Section, Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bldg. 8, B1A07, Bethesda, MD 20892, USA
4
Department of Metabolic Regulation, Shinshu University School of Medicine, Matsumoto, Japan
5
Research Center for Social Systems, Shinshu University, Matsumoto, Japan
6
Department of Orthopedic Surgery, Nagano Prefectural Kiso Hospital, Kiso, Japan
Invasive liver abscess syndrome (ILAS) is one of the worldwide emerging infectious diseases which is characterized by liver abscess and metastatic infection caused by Klebsiella pneumoniae (K. pneumoniae) [1]. K. pneumoniae is a well-known pathogen that causes liver abscess. The serious liver abscess cases show extrahepatic complications resulting from bacterial hematogenous dissemination have been reported mainly from s
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