A contrast-enhanced CT abdomen revealed a large lobulated and
multiloculated intrahepatic lesion with fluid density content, occupying
the right lobe involving segment VI and VII, measuring 8.1 x 6.7 x 7.4
cm (in anteroposterior, transverse, and coronal dimensions), with
irregular and thick peripheral as well as septal enhancement, surrounded
by tissue edema and minimal free fluid and fat stranding in the
subhepatic region. The finding was suggestive of hepatic abscess
(Figure 1 ). He underwent ultrasound-guided drainage of the right
liver lobe abscess and yellowish pus was aspirated. Cultures from the
aqueous and vitreous fluid revealed Klebsiella pneumoniae. Pus
culture from the liver abscess grew the Klebsiella pneumoniae with similar sensitivity. Two sets of blood cultures along with fungal
cultures were negative.
Magnetic resonance imaging (MRI) head and orbit was done which showed
extensive inflammatory changes involving the right orbit, preseptal,
postseptal regions and vitreous chamber with diffusion restriction
suggestive of right eye panophthalmitis (as the inflammatory changes
extend beyond the scleral lining by definition). The right lens was
subluxed laterally and the medial aspect of the uvea and sclera was
thickened, irregular and detached laterally as along with the presence
of a hemorrhagic component in the medial aspect of the right lobe
(Figure2 and 3 ). These findings may be attributed to extensive
inflammatory changes or could be related to the recent surgical
intervention. A ring-enhancing lesion with central diffusion restriction
was noted in the inferior aspect of the left middle cerebellar peduncle
measuring 11 x 7 mm, representing abscess along with moderate
perilesional vasogenic edema (Figure 4 ).
Based on the culture and sensitivity of the organism, antibiotics were
shifted to ceftriaxone for better CNS penetration. The patient,
unfortunately, had to undergo right eye evisceration for source control.
He was discharged on oral trimethoprim-sulfamethoxazole with a follow-up
MRI head to document the clearance of infection.