Abstract
RATIONALE: Hypervirulent Klebsiella pneumoniae (hvKp) can cause an invasive syndrome characterized by multi-organ abscesses. While liver abscess and bacteremia are common, secondary brain abscess is a rare but life-threatening complication. The purpose of this case report is to illustrate the diagnostic and therapeutic challenges in managing such severe KPIS cases and to emphasize key management strategies that can lead to successful outcomes, thereby enhancing clinician awareness of this complex syndrome. PATIENT CONCERNS: A 37-year-old male presented with fever and altered mental status, which subsequently progressed to septic shock and hypoxemia, requiring intensive care. DIAGNOSES: KPIS with liver abscess, bacteremia, pneumonia, and secondary brain abscess due to hvKp infection. INTERVENTIONS: The patient received meropenem via extended infusion, fluid resuscitation, glycemic control, and supportive care. OUTCOMES: The patient's condition improved significantly within 5 days of targeted therapy, manifested by the resolution of fever, successful extubation, and normalization of key laboratory parameters (including white blood cell count, C-reactive protein, and procalcitonin). He was discharged from the ICU after 15 days, exhibiting only mild residual right-sided weakness. Crucially, follow-up imaging at 3 months revealed complete resolution of the liver and brain abscesses, with no evidence of recurrence. LESSONS: This case underscores the importance of early recognition, aggressive antimicrobial therapy, glycemic control, and the utility of next-generation sequencing in diagnosing hvKp infections. Strict glycemic management and susceptibility-guided therapy are critical to preventing complications and improving outcomes.