P3072 - Mind the Gap: A Rare Case of Klebsiella pneumoniae Liver Abscess From Cryptic Maxillary Sinusitis

Kristen Santana, MD, Alisha Menon, MD, Saadia Nabi, MD, Luis G. Santiago Zayas, MD, Sinay Ceballos, MD, Ramasamy Nathan, MD
Aventura Hospital, Aventura, FL

Introduction: Pyogenic liver abscesses are typically polymicrobial.1 2 Klebsiella pneumoniae, KLAS has been documented to account for up to 50% of pyogenic liver abscesses (PLA) in Asian populations.3 Most common routes for hepatic invasion include from the biliary tree , hepatic artery , portal vein,, direct extension from contiguous focus of infection, and from trauma.4 Here we present a case of KLAS secondary to chronic sinusitis from a complicated dental extraction.

Case Description/Methods: A 42-year-old male with no reported past medical history was brought to the Emergency Department due to concern for 1 day of febrile syndrome. Initial labs revealed leukopenia, an elevated serum creatinine, and a total bilirubin of 3.3 with associated mild transaminitis. The physical exam was unremarkable. Imaging studies with ultrasound, CT, and MRI confirmed gallstones and 2 complex liver abscesses measuring 4.7 cm and 1.8 cm. Patient was found to have Klebsiella bacteremia. After further questioning, the patient revealed a remote history of a complicated dental extraction a decade ago in Russia. Exam of the oral cavity revealed a fistulous dental tract in the right upper jaw. He subsequently underwent IR-guided drainage of the liver abscesses. The aspirate culture yielded Klebsiella pneumoniae. Subsequent bidirectional endoscopies did not reveal any other possible source. CT of the sinuses confirmed a focal defect in the right superior 1st molar tooth with communication between the right maxillary sinus and oral cavity.

Discussion: Klebsiella pneumoniae is a known colonizer of the oral cavity in immunocompromised patients or patients with poor dental hygiene. Review of the literature does not reveal an association between dental manipulation, chronic sinusitis, and KLAS liver abscess. 8 75% of patients will have an abscess in the right hepatic lobe on high quality imaging.Multiple serotypes of KLAS have been discovered, but the most prevalent is the virulent K1 capsular serotype3 Infection in healthy individuals with hvKp hepatic abscesses has been associated with significant morbidity and mortality.10 This case highlights the importance of careful and detailed history taking and physical examination to discover the source of cryptic liver abscesses.



Disclosures:


Kristen Santana, MD, Alisha Menon, MD, Saadia Nabi, MD, Luis G. Santiago Zayas, MD, Sinay Ceballos, MD, Ramasamy Nathan, MD. P3072 - Mind the Gap: A Rare Case of <i>Klebsiella pneumoniae</i> Liver Abscess From Cryptic Maxillary Sinusitis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.