PMC9852881_01
Contrast-enhanced computed tomography images of the liver. (A) Multiloculated liver abscess (white arrows) occupying the right lobes of the liver extending across the right hepatic vein. (B) Coronal image revealing multiloculated liver abscess (white arrows) 15 cm in diameter.
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F1
Abdominal computed tomography showed a multiloculated liver abscess 15 cm in diameter in the right lobes of the liver extending across the right hepatic vein (Figure 1). The additional abscess drainage was performed 1 week after the initial drain placement due to inadequate drainage, and finally, five drainage tubes were placed into the multiloculated liver abscess (Supplementary Figure 1).
Polymerase chain reaction (PCR) applied to the pus of the liver abscess. PCR with extracted DNA from the pus of the abscess revealed amplification of the Klebsiella pneumoniae serotype K1 specific locus (wzyKPK1), rmpA, and magA fragments that were detected by electrophoresis on 2.0% agarose.
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F2
The PCR determined the amplification of specific genes for serotype K1, a regulator of mucoid phenotype A (rmpA), and mucoid associated gene A (magA), which was confirmed by Sanger sequencing (Figure 2). Although the abscess in the posterior segments of the liver had shrunk to a diameter of 8 cm at 4 weeks after drainage, the patient recovered from sepsis, but still had low-grade fever (occasionally 38 C), an elevated white blood cell count of 10,300/muL, C-reactive protein level of 6 U/L (Supplementary Figure 2), and continued to have symptoms of a chronic inflammation with persistent hyper mucus discharge from the liver abscess via five drainage tubes (Figure 3).
Contrast-enhanced computed tomography images of the liver. (A) Right hepatic vein separated from the multiloculated liver abscess (white arrows). (B) Coronal image revealing multiloculated liver abscess (white arrows) with drainage tubes 8 cm in diameter.
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F3
Although the abscess in the posterior segments of the liver had shrunk to a diameter of 8 cm at 4 weeks after drainage, the patient recovered from sepsis, but still had low-grade fever (occasionally 38 C), an elevated white blood cell count of 10,300/muL, C-reactive protein level of 6 U/L (Supplementary Figure 2), and continued to have symptoms of a chronic inflammation with persistent hyper mucus discharge from the liver abscess via five drainage tubes (Figure 3). The abscess was close to the root of Glisson's sheath of the right posterior section; therefore, the right posterior sectionectomy of the liver, including the liver abscess, was performed (Supplementary Figure 3).