PMC10080706_01
The timeline of the patient. The patient was admitted to the ICU of Hainan General Hospital on October 21, 2021, due to persistent fever and abdominal pain. He was diagnosed with a liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae. After 58 days of hospitalization, the patient was discharged.
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A 57 year-old male patient was admitted to the intensive care unit (ICU) of Hainan General Hospital on October 21, 2021, due to persistent fever and abdominal pain (Figure 1).
Imaging test results of the patient. (a)-(d) Lung CT results on October 21 (Day 1), November 3 (Day 14), November 18 (Day 29), and December 7 (Day 48), respectively. (e)-(i) Liver CT results on October 21 (Day 1), October 22 (Day 2), November 3 (Day 14), November 18 (Day 29), and December 7 (Day 48), respectively. (j) and (k) Abdominal CT results on November 3 (Day 14). (l) Abdominal CT results on November 18 (Day 29). (m) Lumbar MRI results on December 8 (Day 49).
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Computed tomography (CT) showed high-density shadows and exudation in the right lung, and quasi-circular low-density lesions with unclear borders in the liver (Figure 2a and e). Enhanced CT on October 22 (Day 2) revealed quasi-circular low-density lesions (2.5 cm x 3.8 cm), indicating liver abscess (Figure 2f). CT showed that the liver abscess was slightly smaller (2.4 cm x 3.0 cm), and suspicious foci of infection in the L5 vertebral body and paravertebral soft tissues were found (Figure 2b, g, and j). Considering the positive K. pneumoniae in blood and liver abscess drainage fluid, as well as the subsequent infection in multiple tissues, hvKp was suspected, which has been reported to be more likely to cause liver abscesses with extrahepatic complications [2]. Repeated CT showed that the liver abscess was significantly smaller (2.2 cm x 2.0 cm), but suspicious infectious lesions in the paravertebral soft tissues were unchanged, exudative lesions in the lower lobes of bilateral lungs, around the right psoas muscle, and in the right pelvic wall even developed (Figure 2c, h, and k). Repeated CT before discharge (Day 48) showed infectious lesions of vertebral endplate cartilage and multiple scattered exudations or inflammation of para-vertebral soft tissues, waist muscle, and hip muscle (Figure 2d and i). His liver abscess was relieved compared to before but low-density lesions were still observed (Figure 2l and m).
The depth and identity of detected K. pneumoniae reads by mNGS using blood on October 22 (Day 2) (a) as well as using blood (b) and liver drainage (c) on November 4 (Day 15). The identity of most reads was >99%.
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The blood sample (Day 3) was simultaneously collected for mNGS detection, which revealed a total of 19,013 unique reads of K. pneumoniae with a genome coverage of 27.51% (Figure 3a). Repeated mNGS using blood and liver abscess drainage fluid on November 4 (Day 15) revealed 2,336 and 729,151 unique reads of K. pneumoniae (Figure 3b and c), respectively.