Case Report: Klebsiella pneumoniae-associated pyogenic spondylitis and occult intrahepatic cholangiocarcinoma during calculous cholangitis.
4 affiliations
- 1Department of Infectious Diseases, The Second People's Hospital of Quzhou, Quzhou, Zhejiang, China.
- 2Graduate School of Shanxi Medical University, Taiyuan, Shanxi, China.
- 3Department of Radiology, Wangdian People's Hospital, Jiaxing, Zhejiang, China.
- 4Department of Rheumatology and Immunology, The Second People's Hospital of Quzhou, Quzhou, Zhejiang, China.
Abstract
Background
Klebsiella pneumoniae is a common Gram-negative pathogen in biliary tract infections and may cause deep-seated infection following bacteremia, although vertebral involvement is uncommon. Severe biliary infection and stone disease may also complicate the recognition of coexisting hepatic malignancy.Case presentation
A 51-year-old woman presented with calculous acute obstructive suppurative cholangitis complicated by septic shock and multiorgan dysfunction. Blood and bile cultures yielded Klebsiella pneumoniae, and her condition improved after urgent biliary drainage and antimicrobial therapy. During a subsequent admission, she developed progressive low-back pain. Lumbar magnetic resonance imaging showed abnormalities involving the L3/4 vertebrae and adjacent paravertebral tissues, initially raising suspicion of spinal tuberculosis. Vertebral biopsy demonstrated focal suppurative inflammation, and metagenomic next-generation sequencing of the same tissue detected 33,735 K. pneumoniae-specific reads, with a relative abundance of 82.18% and genome coverage of 59.7%, together with multiple hypervirulence-associated determinants. These findings supported a diagnosis of K. pneumoniae-associated pyogenic spondylitis. Meanwhile, serial hepatobiliary imaging showed regression of the right hepatic abnormalities as the infection improved, whereas a focal lesion in the left liver persisted. Subsequent imaging raised suspicion of cholangiocarcinoma, and histopathologic examination after surgical resection confirmed poorly differentiated intrahepatic cholangiocarcinoma.Conclusion
This case underscores the importance of maintaining diagnostic vigilance even after an initial diagnosis has been established. New focal symptoms or abnormalities that persist or follow a different clinical course should not be automatically attributed to the original disease process, and the possibility of additional coexisting diagnoses should remain under consideration.
Related
- Number of examined lymph nodes and overall survival in intrahepatic cholangiocarcinoma: a population-based study suggesting a staging benefit
- OLFM4 promotes intrahepatic cholangiocarcinoma progression through a PKM2-glycolysis-histone lactylation feedback loop.
- Same organ, divergent immunity: T-cell exhaustion versus stromal exclusion in hepatocellular carcinoma and intrahepatic cholangiocarcinoma
- Single-cell and spatial transcriptomics in intrahepatic cholangiocarcinoma: spatial immune ecosystems, metabolic remodeling, and immunotherapeutic implications
- Intrahepatic Cholangiocarcinoma Staging and Classification Systems: An Updated Narrative Review.
BibTeX
@article{yang2026case,
title = {{Case Report: Klebsiella pneumoniae-associated pyogenic spondylitis and occult intrahepatic cholangiocarcinoma during calculous cholangitis.}},
author = {Zheng Yang and Yuhe Yan and Hui Wang and Hua Zhou and Mengyi Zheng},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1967835},
url = {https://europepmc.org/article/MED/42908652},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report: Klebsiella pneumoniae-associated pyogenic spondylitis and occult intrahepatic cholangiocarcinoma during calculous cholangitis.
AU - Zheng Yang
AU - Yuhe Yan
AU - Hui Wang
AU - Hua Zhou
AU - Mengyi Zheng
PY - 2026
DA - 2026/10/07
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1967835
UR - https://europepmc.org/article/MED/42908652
AB - Background Klebsiella pneumoniae is a common Gram-negative pathogen in biliary tract infections and may cause deep-seated infection following bacteremia, although vertebral involvement is uncommon. Severe biliary infection and stone disease may also complicate the recognition of coexisting hepatic malignancy.Case presentation A 51-year-old woman presented with calculous acute obstructive suppurative cholangitis complicated by septic shock and multiorgan dysfunction. Blood and bile cultures yielded Klebsiella pneumoniae, and her condition improved after urgent biliary drainage and antimicrobial therapy. During a subsequent admission, she developed progressive low-back pain. Lumbar magnetic resonance imaging showed abnormalities involving the L3/4 vertebrae and adjacent paravertebral tissues, initially raising suspicion of spinal tuberculosis. Vertebral biopsy demonstrated focal suppurative inflammation, and metagenomic next-generation sequencing of the same tissue detected 33,735 K. pneumoniae-specific reads, with a relative abundance of 82.18% and genome coverage of 59.7%, together with multiple hypervirulence-associated determinants. These findings supported a diagnosis of K. pneumoniae-associated pyogenic spondylitis. Meanwhile, serial hepatobiliary imaging showed regression of the right hepatic abnormalities as the infection improved, whereas a focal lesion in the left liver persisted. Subsequent imaging raised suspicion of cholangiocarcinoma, and histopathologic examination after surgical resection confirmed poorly differentiated intrahepatic cholangiocarcinoma.Conclusion This case underscores the importance of maintaining diagnostic vigilance even after an initial diagnosis has been established. New focal symptoms or abnormalities that persist or follow a different clinical course should not be automatically attributed to the original disease process, and the possibility of additional coexisting diagnoses should remain under consideration.
SN - 2296-858X
ER -