A case of refractory liver abscess due to hypermucoviscous Klebsiella pneumoniae resolved by hepatectomy

A 65-year-old woman was admitted with fever, abdominal pain, and laboratory markers indicating an inflammatory reaction. An abdominal ultrasound (US) showed a 60-mm hyperechoic lesion in the left lateral segment of the liver diagnosed as a liver abscess. Antibiotics were administered. Percutaneous drainage was attempted but was difficult because of poor liquefaction. On day 6, the abscess had enlarged and progressed to involve the medial segment. Hypermucoviscous Klebsiella pneumoniae was detected in blood and abscess cultures. Repeat US showed poor liquefaction, suggesting that percutaneous drainage would again fail. As the abscess was deemed resistant to medical treatment, a left hepatic lobectomy was performed. Postoperatively, the patient's general condition and inflammatory reaction quickly improved. Hypermucoviscous K. pneumoniae is often resistant to antibiotics because of the organism's extremely mucoid capsule. Percutaneous drainage is also difficult, so surgical resection should be considered.