DOI: https://doi.org/10.36347/sjmcr.2026.v14i06.031

Pages: 1451-1453

Invasive Klebsiella pneumoniae liver abscess syndrome (IKLAS) is an increasingly recognised clinical entity characterised by pyogenic liver abscess, bacteraemia and metastatic infection, particularly in patients with diabetes mellitus. Early manifestations are frequently non-specific and may mimic common primary care presentations. We report the case of a 58-year-old man with poorly controlled type 2 diabetes mellitus and hypertension who initially presented to primary care with nocturnal positional dry cough. Symptoms were managed conservatively as probable gastroesophageal reflux disease or upper airway cough syndrome. Over the following weeks, he developed progressive fatigue, anorexia, significant weight loss, right upper quadrant pain, fever and jaundice. Urgent referral to secondary care revealed severe sepsis with marked leukocytosis, cholestatic liver dysfunction, acute kidney injury and multiple hepatic abscesses. Blood cultures and liver abscess cultures grew Klebsiella pneumoniae. The clinical course was complicated by endogenous endophthalmitis causing visual impairment and right-sided pulmonary embolism requiring anticoagulation with apixaban. Management included broad spectrum intravenous antibiotics, image-guided drainage of liver abscesses, intravitreal antimicrobial therapy and multidisciplinary specialist care. The patient was discharged on a prolonged antimicrobial regimen consisting of two weeks of intravenous antibiotics followed by four weeks of oral therapy. This case highlights the importance of recognising evolving red flag symptoms in primary care and demonstrates the potentially devastating metastatic complications of invasive Klebsiella pneumoniae infection.