Klebsiella pneumoniae pyogenic liver abscess mimicking hepatic malignancy in a non-diabetic patient: A case report from Kazakhstan

Pyogenic liver abscess is an infectious condition associated with significant morbidity and mortality, with Klebsiella pneumoniae emerging as a major pathogen. We report a case of Klebsiella pneumoniae pyogenic liver abscess in a 76-year-old woman from Kazakhstan, representing one of the first indexed reports from Central Asia. The patient presented with prolonged fever, jaundice, and constitutional symptoms without diabetes mellitus. Initial ultrasound revealed a large heterogeneous hepatic mass with a solid, tumor-like appearance, raising concern for malignancy in the setting of chronic hepatitis B infection. MRI and contrast-enhanced CT demonstrated diffusion restriction, multiloculated architecture, and mild peripheral and septal enhancement without arterial hyperenhancement or venous washout, favoring hepatic abscess over hepatocellular carcinoma. The solid, tumor-like ultrasound appearance, atypical for a pyogenic abscess in its resemblance to hepatic malignancy, posed the primary diagnostic challenge, underscoring the value of multimodal imaging in characterizing hepatic lesions. Additionally, KPLA should be considered in the differential diagnosis even in the absence of classical metabolic risk factors and in regions with limited epidemiological data.