A Rare Case of Necrotizing Pneumonia and Pleural Empyema Secondary to Transdiaphragmatic Extension and Perforation of a Pyogenic Liver Abscess

This article presents a rare case of an elderly patient with diabetes and hypertension who developed a primary pyogenic liver abscess (PLA) that subsequently disseminated to the lungs by contiguity, resulting in diaphragmatic perforation complicated by necrotizing pneumonia, hepatobronchial fistula, and pleural empyema. In this case, percutaneous drainage of the PLA was unsuccessful, necessitating surgical intervention, which confirmed the diaphragmatic perforation. <i>Klebsiella pneumoniae</i> was isolated from the liver abscess samples sent for microbiological analysis, while blood cultures were negative. Despite extensive local infection and systemic dissemination consistent with invasive liver abscess syndrome, as well as progression to septic shock requiring intensive care unit admission, the patient achieved a gradual yet full recovery and ultimately returned to an active daily life. This was only possible due to the effective control of the infectious focus, combined with appropriate antibiotic therapy and supportive measures.