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A Klebsiella pneumoniae liver abscess presenting with myasthenia and tea-colored urine: A case report and review of 77 cases of bacterial rhabdomyolysis.

Abstract Rhabdomyolysis is a well-known syndrome in clinical practice, although rhabdomyolysis caused by a liver abscess is rarely reported and the patient may lack symptoms that are associated with a primary site of infection. Early recognition of this possibility is needed to avoid diagnostic delay and facilitate treatment. We report the case of a 71-year-old woman with a Klebsiella pneumoniae (KP) pyogenic liver abscess who presented with myasthenia and tea-colored urine and also review the 77 reported cases of bacterial rhabdomyolysis.
PMID
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Authors

Mayor MeshTerms

Klebsiella pneumoniae

Keywords
Journal Title medicine
Publication Year Start




PMID- 29390582
OWN - NLM
STAT- MEDLINE
DCOM- 20180212
LR  - 20180212
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 51
DP  - 2017 Dec
TI  - A Klebsiella pneumoniae liver abscess presenting with myasthenia and tea-colored 
      urine: A case report and review of 77 cases of bacterial rhabdomyolysis.
PG  - e9458
LID - 10.1097/MD.0000000000009458 [doi]
AB  - RATIONALE: Rhabdomyolysis is a well-known syndrome in clinical practice, although
      rhabdomyolysis caused by a liver abscess is rarely reported and the patient may
      lack symptoms that are associated with a primary site of infection. Early
      recognition of this possibility is needed to avoid diagnostic delay and
      facilitate treatment. We report the case of a 71-year-old woman with a Klebsiella
      pneumoniae (KP) pyogenic liver abscess who presented with myasthenia and
      tea-colored urine and also review the 77 reported cases of bacterial
      rhabdomyolysis. PATIENT CONCERNS: The patient was 71 years old and presenting
      with a 7-day history of myasthenia and a 3-day history of tea-colored urine, but 
      without fever or abdominal pain. DIAGNOSES: Laboratory testing in our case
      revealed rhabdomyolysis, and blood culture revealed KP. Abdominal ultrasonography
      revealed a hypoechoic enclosed mass, and computed tomography (CT) revealed an
      enclosed low-density mass (8.3 x 6.6 x 6.1 cm). The main diagnoses were a
      pyogenic liver abscess with rhabdomyolysis. INTERVENTIONS: Empirically
      intravenous piperacillin-sulbactam and intravenous potassium treatment, as well
      as fluid infusions and other supportive treatments were provided after admission.
      After the diagnosis was confirmed and susceptibility test results were available,
      we adjusted the antibiotics to cefoperazone and sulbactam, which were maintained 
      for 6 weeks. OUTCOMES: The patient's symptoms relieved and the abnormal
      laboratory parameters corrected. Follow-up abdominal ultrasonography at 24 months
      after her discharge revealed that the abscess had disappeared. LESSONS: Early
      recognition and careful consideration of the underlying cause of rhabdomyolysis
      are critical to improving the patient's prognosis. Thus, physicians should
      carefully consider the underlying cause in elderly patients who present with
      rhabdomyolysis, as they may lack symptoms of a primary infection.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Deng, Lihua
AU  - Deng L
AD  - Department of Geriatrics, Peking University People's Hospital, Beijing, P. R.
      China.
FAU - Jia, Rong
AU  - Jia R
FAU - Li, Wei
AU  - Li W
FAU - Xue, Qian
AU  - Xue Q
FAU - Liu, Jie
AU  - Liu J
FAU - Miao, Yide
AU  - Miao Y
FAU - Wang, Jingtong
AU  - Wang J
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Aged
MH  - Humans
MH  - Klebsiella Infections/complications/*diagnosis/pathology/urine
MH  - *Klebsiella pneumoniae
MH  - Liver Abscess/complications/*diagnosis/pathology/urine
MH  - Muscle Weakness/*etiology/microbiology/urine
MH  - Rhabdomyolysis/*etiology/microbiology/urine
PMC - PMC5758284
EDAT- 2018/02/03 06:00
MHDA- 2018/02/13 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/13 06:00 [medline]
AID - 10.1097/MD.0000000000009458 [doi]
AID - 00005792-201712220-00169 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(51):e9458. doi: 10.1097/MD.0000000000009458.