Rapidly Fatal Gas‐Forming Pyogenic Psoas Abscess Caused byKlebsiella pneumoniae

To the Editor—Bilateral gas-forming pyogenic psoas abscesses caused by Klebsiella pneumoniae have rarely been reported in the English-language literature [1–3]. We describe a 78-year-old man who had a 10-year history of hypertension and diabetes mellitus controlled with antihypertensive and oral hypoglycemic agents. Eight weeks before this visit, the patient had presented to the emergency department with high fever and rigors. Abdominal CT revealed a liver abscess (size, 3 × 4 cm) over the right lobe. No metastatic lesions, such as endophthalmitis, or involvement of psoas or spine was found during the hospitalization (figure 1A). Repeated echo-guided aspiration was required before resolution of the abscess. Intravenous ceftriaxone (1 g every 12 h) was administered for 2 weeks, followed by oral cefixime (200 mg every 12 h) for 4 weeks. Cultures of blood samples (isolate A) and liver aspirate specimens (isolate B) both yielded K. pneumoniae with the hypermucovicosity phenotype [1]; the isolate was determined to be susceptible to cefazolin, cefmetazole, and ceftriaxone by the standard disk diffusion method.