Klebsiella pneumoniae bacteremia and renosplenic abscesses without intestinal symptoms as the initial manifestations of non-steroidal anti-inflammatory drug-induced colitis: a rare case report

BMC Gastroenterology

Wei-Ru Lin³  Chao-Hung Kuo⁵  Yen-Hsu Chen¹  Chun-Yu Lin⁴  Po-Liang Lu⁴  Hung-Ling Huang² 

[1] Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100, Tzyou 1st Road, Kaohsiung 807, Taiwan;School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

关键词: Renosplenic abscesses;    Klebsiella pneumoniae;    Bacteremia;    Colitis;    Non-steroidal anti-inflammatory drugs;   

Others  :  857599
DOI  :  10.1186/1471-230X-13-139

 received in 2013-04-26, accepted in 2013-09-20,  发布年份 2013

【 摘 要 】

Background

Non-steroidal anti-inflammatory drugs (NSAIDs), the most widely prescribed drugs in the world, can cause gastrointestinal damage, including colitis. However, the prevalence of NSAID-induced colitis is unknown because the disease is often asymptomatic.

Case presentation

We report the case of a 64-year-old female patient with a history of long-term NSAID use, who was hospitalized with septic shock caused by Klebsiella pneumoniae bacteremia. Computed tomography revealed multiple renal and splenic abscesses with diffuse colon wall thickening. A colonoscopy confirmed colitis with diffuse ulcers. NSAIDs were discontinued after this hospitalization. The abscesses improved after antibiotic treatment. A short course of balsalazide treatment was given under the suspicion of ulcerative colitis. Balsalazide was discontinued four months later due to a non-compatible clinical course. A follow-up colonoscopy two years later revealed a normal colon mucosa, and NSAID-induced colitis was diagnosed.

Conclusion

This is the first reported case of combined bacterial splenic and renal abscesses without intestinal manifestations as the initial presentation of NSAID-induced colitis. In contrast to cases of K. pneumoniae bacteremia with primary liver abscesses in patients with diabetes mellitus in Taiwan, we presented the first case with abscesses caused by community-acquired K. pneumoniae in the kidneys and spleen without liver invasion. In conclusion, our case report alerts clinicians to the possibility that K. pneumoniae bacteremia combined with multiple abscesses can be associated with severe NSAID-induced colitis.

【 授权许可】

   
2013 Huang et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Deshpande V, Hsu M, Kumarasinghe MP, Lauwers GY: The clinical significance of incidental chronic colitis: a study of 17 cases. Am J Surg Pathol 2010, 34:463-469.
• [2]Kurahara K, Matsumoto T, Iida M, Honda K, Yao T, Fujishima M: Clinical and endoscopic features of nonsteroidal anti-inflammatory drug-induced colonic ulcerations. Am J Gastroenterol 2001, 96:473-480.
• [3]Puspok A, Kiener HP, Oberhuber G: Clinical, endoscopic, and histologic spectrum of nonsteroidal anti-inflammatory drug-induced lesions in the colon. Dis Colon Rectum 2000, 43:685-691.
• [4]Tanner AR, Raghunath AS: Colonic inflammation and nonsteroidal anti-inflammatory drug administration. An assessment of the frequency of the problem. Digestion 1988, 41:116-120.
• [5]Katsinelos P, Christodoulou K, Pilpilidis I, Xiarchos P, Papagiannis A, Dimiropoulos S, Amperiadis P, Vasiliadis T, Tarpagos A, Katsos I, Eugenidis N: Colopathy associated with the systemic use of nonsteroidal antiinflammatory medications. An underestimated entity. Hepatogastroenterology 2002, 49:345-348.
• [6]Fung CP, Lin YT, Lin JC, Chen TL, Yeh KM, Chang FY, Chuang HC, Wu HS, Tseng CP, Siu LK: Klebsiella pneumoniae in gastrointestinal tract and pyogenic liver abscess. Emerg Infect Dis 2012, 18:1322-1325.
• [7]Podschun R, Ullmann U: Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev 1998, 11:589-603.
• [8]Kang CI, Kim SH, Bang JW, Kim HB, Kim NJ, Kim EC, Oh MD, Choe KW: Community-acquired versus nosocomial Klebsiella pneumoniae bacteremia: clinical features, treatment outcomes, and clinical implication of antimicrobial resistance. J Korean Med Sci 2006, 21:816-822.
• [9]Wu HS, Wang FD, Tseng CP, Wu TH, Lin YT, Fung CP: Characteristics of healthcare-associated and community-acquired Klebsiella pneumoniae bacteremia in Taiwan. J Infect 2012, 64:162-168.
• [10]Lederman ER, Crum NF: Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. Am J Gastroenterol 2005, 100:322-331.
• [11]Chang KC, Chuah SK, Changchien CS, Tsai TL, Lu SN, Chiu YC, Chen YS, Wang CC, Lin JW, Lee CM, Hu TH: Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. World J Gastroenterol 2006, 12:460-464.
• [12]Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY: Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis 2012, 12:881-887.
• [13]Lee CH, Leu HS, Hu TH, Liu JW: Splenic abscess in southern Taiwan. J Microbiol Immunol Infect 2004, 37:39-44.
• [14]Lee BE, Seol HY, Kim TK, Seong EY, Song SH, Lee DW, Lee SB, Kwak IS: Recent clinical overview of renal and perirenal abscesses in 56 consecutive cases. Korean J Intern Med 2008, 23:140-148.
• [15]Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O’Neill PJ, Chow AW, Dellinger EP, Eachempati SR, et al.: Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010, 50:133-164.
• [16]Ferraioli G, Brunetti E, Gulizia R, Mariani G, Marone P, Filice C: Management of splenic abscess: report on 16 cases from a single center. Int J Infect Dis 2009, 13:524-530.
• [17]Tu YC, Lu MC, Chiang MK, Huang SP, Peng HL, Chang HY, Jan MS, Lai YC: Genetic requirements for Klebsiella pneumoniae-induced liver abscess in an oral infection model. Infect Immun 2009, 77:2657-2671.
• [18]Jeong SW, Jang JY, Lee TH, Kim HG, Hong SW, Park SH, Kim SG, Cheon YK, Kim YS, Cho YD, et al.: Cryptogenic pyogenic liver abscess as the herald of colon cancer. J Gastroenterol Hepatol 2012, 27:248-255.
• [19]Goldstein NS, Cinenza AN: The histopathology of nonsteroidal anti-inflammatory drug-associated colitis. Am J Clin Pathol 1998, 110:622-628.
• [20]Ravi S, Keat A, Keat E: Colitis caused by non-steroidal anti-inflammatory drugs. Postgrad Med J 1986, 62:773-776.
• [21]Witham R: Voltaren (diclofenac sodium)-induced ileocolitis. Am J Gastroenterol 1991, 86:246-247.
• [22]Pan YS, Chen LT, Tseng CA, Su YC, Jan CM, Wang WM, Tsai KB: Clinical and endoscopic features of non-steroidal anti-inflammatory drug-induced colorectal ulcerations. J Formos Med Assoc 2005, 104:804-810.
• [23]Shibuya T, Ohkusa T, Yokoyama T, Harada A, Beppu K, Sakamoto N, Osada T, Nagahara A, Terai T, Otaka M: Colonic mucosal lesions associated with long‒term or short‒term administration of nonsteroidal anti‒inflammatory drugs. Colorectal Dis 2010, 12:1113-1121.
• [24]Alfadda AA, Storr MA, Shaffer EA: Eosinophilic colitis: epidemiology, clinical features, and current management. Therap Adv Gastroenterol 2011, 4:301-309.
• [25]Gentric A, Pennec Y: Diclofenac-induced pseudomembranous colitis. Lancet 1992, 340:126-127.
• [26]Ballinger A: Adverse effects of nonsteroidal anti-inflammatory drugs on the colon. Curr Gastroenterol Rep 2008, 10:485-489.
• [27]Kefalakes H, Stylianides TJ, Amanakis G, Kolios G: Exacerbation of inflammatory bowel diseases associated with the use of nonsteroidal anti-inflammatory drugs: myth or reality? Eur J Clin Pharmacol 2009, 65:963-970.