Hypervirulent Klebsiella pneumoniae Mediated Hepatic Infarction Septic Shock After Rectal Cancer Surgery: A Case Report

Abstract

The liver receives blood from both the hepatic artery and portal vein. Hepatic infarction is rare in clinical practice as both the hepatic artery and portal vein can supply blood to the liver. Here, we reported a case of a 75-year-old man who underwent radical laparoscopic surgery for rectal cancer and subsequently developed hepatic infarction. The patient experienced severe infection, as well as circulatory and respiratory failure on the third day after surgery. The patient presented with high fever, chest tightness, shortness of breath, decreased blood oxygen saturation and blood pressure. The leukocyte count decreased from 8.10 × 10^9/L to 1.75 × 10^9/L. Procalcitonin (PCT) levels increased from 1.02 ng/mL to 67.14 ng/mL, and eventually reaching levels over 200 ng/mL. Enhanced abdominal computed tomography (CT) confirmed the presence of hepatic infarction, but no thrombosis was observed in the hepatic artery or portal vein. Metagenomic next-generation sequencing (mNGS) identified hypervirulent Klebsiella pneumoniae (hvKp) in the patient’s blood and ascites, one day earlier than the detection results using traditional culture methods. The patient was diagnosed with hepatic infarction combined with septic shock caused by hvKp. This case emphasizes that in the high-risk group of thrombosis, infection can trigger exacerbated hepatic infarction events, particularly in cases after surgical procedures. For severely ill patients with infectious diseases who are admitted to the ICU with worsening symptoms, it is important to collect appropriate samples and send them for pathogen detection using mNGS in a timely manner. This may aid in early intervention and improve clinical outcomes.

Keywords:

• hepatic infarction
• mNGS
• hypervirulent Klebsiella pneumoniae
• septic shock

Data Sharing Statement

The data presented in the study are deposited in the SRA (https://www.ncbi.nlm.nih.gov/sra/) repository, accession number PRJNA1037706.

Ethics Statement

Since the patient is deceased, written informed consent for publication of her clinical details and clinical images was obtained from the next of kin. This study was approved by the Ethics Review Committee of the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China (Approve No. KY-2024-004-01).

Acknowledgments

The authors would like to thank WillingMed Technology (Beijing) Co., Ltd for providing metagenomic NGS analysis of samples and assistance with data analysis and discusses in this study.

Disclosure

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Additional information

Funding

Authors state no funding involved.