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.