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Revista Española de Enfermedades Digestivas

Print version ISSN 1130-0108

Rev. esp. enferm. dig. vol.107 n.1 Madrid Jan. 2015




Liver abscess due to Klebsiella pneumoniae and its relation to colon lesions

Absceso hepático por Klebsiella pneumoniae y su relación con lesiones colónicas



Key words: Liver abscces. Klebsiella pneumoniae. Tubulovillous adenoma. High grade dysplasia.

Palabras clave: Absceso hepático. Klebsiella pneumoniae. Adenoma tubulovelloso. Displasia alto grado.



Dear Editor,

Pyogenic liver abscesses are often caused by biliary or digestive tract infections. In some cases a firm etiological diagnosis cannot be established -such lesions being classified as cryptogenic abscesses or abscesses of obscure origin. Different studies suggest that in such cases the abscess is produced as a result of disruption of the colon mucosa with secondary bacteremia via the portal route, as occurs for example in large tubulovillous adenomas or colorectal cancer (1,2). The present study describes a patient with relapsing cryptogenic liver abscess due to Klebsiella pneumoniae, in which a colon tubulovillous adenoma with high grade dysplasia was detected.


Case report

A 65-year-old male presented with type 2 diabetes as sole risk factor for the development of liver abscess (1). He was admitted to our hospital in May 2012, with the isolation of Klebsiella pneumoniae. Intravenous antibiotic treatment (piperacillin-tazobactam) was administered for two weeks, with percutaneous drainage under ultrasound guidance. Ten months later the patient presented a new liver abscess caused by the same microorganism in the same location, and which was likewise subjected to conservative management.

Since liver abscesses can originate from colon neoplasms (1,2), we requested colonoscopy, which revealed the presence of a tubulovillous adenoma with high grade dysplasia. Culture of the adenoma biopsy material isolated Klebsiella pneumoniae of a biotype similar to that isolated from the abscess culture. The patient remains asymptomatic 7 months after the end of abscess treatment and 5 months after endoscopic removal of the polyp.



Recently, a review of the Taiwanese public health department including 2,294 individuals with liver abscesses between 2000-2009 reported a greater incidence of colorectal cancer during the follow-up of these patients -Klebsiella pneumoniae being the organism most often isolated in such cases. Taking these data into account, it seems reasonable to perform colonoscopy as a screening method for colon lesions in patients over 60 years of age with liver abscesses (3). This study corroborates the results of other publications that describe a relationship between both conditions (1,2,4,5). It should be mentioned that in Asian countries (Taiwan, South Korea), Klebsiella pneumoniae has displaced other classical pathogens (Staphylococcus, Streptococcus, E. coli) as the main organism isolated in these situations (6,7).

In our case, colonoscopy detected a villous adenoma with high grade dysplasia, and culture moreover yielded the same bacterium as that isolated from the liver abscess. We thus assume that the bacterium reached the liver via the portal route through mucosal disruption favored by the high grade dysplasia of the colon polyp.


Guillermo Ontanilla, José Manuel Herrera, Juan Manuel Alcívar,
Guillermo Martín-Gutiérrez, Cristina Márquez and José Luis Márquez

UGC Digestive Diseases. Hospital Universitario Virgen del Rocío. Sevilla, Spain



1. Jeong SW, Jang JY, Lee TH, Kim HG, Hong SW, Park SH, et al. Cryptogenic pyogenic liver abscess as the herald of colon cancer. J Gastroenterol Hepatol 2012;27:248-55.         [ Links ]

2. Lai HC, Chan CY, Peng CY, Chen CB, Huang WH. Pyogenic liver abscess associated with large colonic tubulovillous adenoma. World J Gastroenterol 2006;12:990-2.         [ Links ]

3. Huang WK, Chang JW, See LC, Tu HT, Chen JS, Liaw CC, et al. Higher rate of colorectal cancer among patients with pyogenic liver abscess with Klebsiella pneumoniae than those without: An 11-year follow-up study. Colorectal Dis 2012;14:e794-801.         [ Links ]

4. Koo HC, Kim YS, Kim SG, Tae JW, Ko BM, Lee TI, et al. Should colonoscopy be performed in patients with cryptogenic liver abscess? Clin Res Hepatol Gastroenterol 2013;37:86-92.         [ Links ]

5. Qu K, Liu C, Wang ZX, Tian F, Wei JC, Tai MH, et al. Pyogenic liver abscesses associated with nonmetastatic colorectal cancers: An increasing problem in Eastern Asia. World J Gastroenterol 2012;18:2948-55.         [ Links ]

6. Chang FY, Chou MY. Comparison of pyogenic liver abscesses caused by Klebsiella pneumoniae and non-K. pneumoniae pathogens. J Formos Med Assoc 1995;94:232-7.         [ Links ]

7. Chung DR, Lee SS, Lee HR, Kim HB, Choi HJ, Eom JS, et al.; and the Korean Study Group for Liver Abscess. Emerging invasive liver abscess caused by K1 serotype Klebsiella pneumoniae in Korea. J Infect 2007;54:578-83.         [ Links ]

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