Klebsiella pneumoniae Liver Abscess in a Filipino Patient With Previously Undiagnosed Diabetes: Successful Conservative Management

Klebsiella pneumoniae is a common pathogen of pyogenic liver abscess (PLA), particularly among individuals with diabetes mellitus and those of Asian ethnicity. A 32-year-old Filipino man with no prior medical history presented with fever, headache, nausea, and vomiting and was found to have new-onset diabetic ketoacidosis (DKA). Laboratory evaluation revealed leukocytosis, thrombocytopenia, elevated liver enzymes, hyperbilirubinemia and lactic acidosis. Abdominal computed tomography (CT) showed hepatosplenomegaly, variable hepatic abnormalities including < 2 cm hypodense lesions and a large ill-defined area of decreased density in the inferior right liver lobe. The patient was hospitalized for sepsis and DKA. Empiric piperacillin–tazobactam was administered for 24 h and subsequently de-escalated to ceftriaxone after blood cultures grew extended-spectrum β-lactamase–negative Klebsiella pneumoniae; ceftriaxone was continued for 4 weeks. Due to the number, size and inaccessible location of the liver lesions, percutaneous drainage was not feasible. After 16-week follow-up, the patient achieved complete clinical recovery and radiological resolution of hepatic lesions. This case highlights variable hepatic lesion presentations in Klebsiella liver abscess (KLA) with successful conservative management without drainage.