A 58-year-old man with poorly controlled diabetes mellitus presents with fever and right upper quadrant pain. CT shows a multiloculated liver abscess. Blood culture grows a gram-negative capsulated organism that produces hypervirulent invasive syndromes in East Asian populations. The most likely causative organism is:

• A Entamoeba histolytica
• B Streptococcus milleri group
• C Klebsiella pneumoniae ✓
• D Escherichia coli

Explanation

Klebsiella pneumoniae is now the leading cause of community-acquired pyogenic liver abscess in diabetic patients, particularly in Asia, where hypervirulent capsular serotypes cause metastatic infection including endophthalmitis. Amoebic abscess yields no bacterial growth and responds to metronidazole. Streptococcus milleri and E. coli are recognised causes but are not specifically linked to diabetes in the way capsulated Klebsiella is. Management combines antibiotics with percutaneous drainage.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.