Pyogenic liver abscesses are a rare clinical entity occurring in an estimated 2.3 per 100,000 of the population. Klebsiella pneumoniae-associated liver abscess syndromes are extremely rare and have not been previously reported in the medical literature during pregnancy.METHODS:
We had a medical librarian perform a professional search using the key words, “pyogenic liver abscess”, “pregnancy”, “pregnant”, “postpartum”, “pyogenic hepatic abscess”, and “Klebsiella pneumoniae” in the English language. We found that pyogenic liver abscesses (PLA) in the antenatal and postpartum period are rare, finding only five cases that have been previously reported in the puerperium. We discovered no cases of Klebsiella pneumoniae liver abscess in pregnancy.RESULTS:
We report a 29 year-old G2P1001 who presented at 11 weeks and 1 day for fever, fatigue, body aches and headache. An infectious workup was initiated and preliminary blood cultures returned with gram negative rods; final cultures results confirmed heavy Klebsiella pneumoniae. During her workup for Klebsiella bacteremia of unknown source, an ultrasound of the liver showed a 4 cm abscess, later confirmed with MRI. She subsequently underwent percutaneous drainage of the liver abscess with culture confirming Klebsiella pneumoniae. Following diagnosis, she received an echocardiogram and an ophthalmology evaluation to rule out invasive disease. She was treated with a two week course of intravenous ceftriaxone therapy and oral metronidazole therapy. She was then transitioned to oral cefixime for a total of four weeks of therapy until abscess resolution was confirmed on follow-up imaging. For the remainder of her pregnancy, she was followed in the high-risk obstetric clinic and delivered a viable female infant at term. At approximately two months postpartum, she continues to be followed closely for mild transaminitis and is otherwise well.CONCLUSION:
Pyogenic liver abscesses are an uncommon etiology of fever in pregnancy. Cryptogenic PLAs are often associated with non-specific symptoms that overlap common pregnancy complaints. Accurate diagnosis requires a thorough fever workup until a source is identified. Our case is the first report of Klebsiella pneumoniae PLA in pregnancy.