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CC BY-NC-ND 4.0 · AJP Rep 2019; 09(03): e251-e255
DOI: 10.1055/s-0039-1692713
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Perinatal Pyogenic Liver Abscess: A Rare Entity and First Reported Case of Klebsiella pneumoniae

Stacey S. Schmiedecke 
1   Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Madigan Army Medical Center, Tacoma, Washington
,
Peter G. Napolitano
1   Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Madigan Army Medical Center, Tacoma, Washington
,
Sarah M. Estrada
1   Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Madigan Army Medical Center, Tacoma, Washington
› Author Affiliations
Further Information

Publication History

14 April 2019

14 May 2019

Publication Date:
20 August 2019 (online)

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Abstract

Introduction Pyogenic liver abscess (PLA) is a rare clinical entity, occurring in ∼2.3 per 100,000 patients. Perinatal PLA syndromes are exceedingly rare with just seven previously described cases in the literature and no prior Klebsiella-associated reports.

Case A 29-year-old gravida 2 para 1 woman at 11 weeks gestation reporting fever, body aches, and headache. Search for an infectious source identified a 4-cm liver abscess. Percutaneous drainage confirmed Klebsiella pneumoniae infection. The patient was treated with antibiotics until imaging verified complete resolution of the abscess.

Conclusion PLA is an uncommon etiology of sepsis in pregnancy. A thorough workup until a source was identified resulted in accurate diagnosis. This allowed for directed therapy and prompt recovery, undoubtedly contributing to favorable pregnancy outcomes in this first report of Klebsiella-associated perinatal PLA.

Keywords

pyogenic liver abscess - liver abscess - pregnancy - sepsis - perinatal infection

Financial Disclosures

None.


Précis

Perinatal pyogenic liver abscess is a rare but dangerous etiology of maternal sepsis, requiring thorough infectious work-up and prompt treatment to improve maternal-fetal outcomes.


Teaching Points

Pyogenic liver abscesses are an uncommon etiology of fever in the puerperium and are often associated with nonspecific symptoms that overlap common pregnancy complaints.


Accurate diagnosis of a pyogenic liver abscess requires thorough fever workup until a source is identified.


Astute obstetric care and a multidisciplinary approach can allow for prompt diagnosis and directed therapy, improving outcomes for both mother and fetus.


Note

This article was presented at the American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting, Austin, Texas, April 2018.


 

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