Interventional treatment of a bacterial embolus in the retrohepatic inferior vena cava secondary to invasive Klebsiella pneumoniae liver abscess syndrome: a case report and literature review.

BACKGROUND: Retrohepatic inferior vena cava (IVC) bacterial embolism secondary to invasive Klebsiella pneumoniae liver abscess syndrome (IKPLAS) is extremely rare, and no English literature has reported its interventional treatment to date. This study presents a detailed case of such interventional treatment, providing references for clinical practice. CASE PRESENTATION: A 53-year-old female with a 1-year history of type 2 diabetes presented with fever. Laboratory tests showed elevated inflammatory markers, blood culture confirmed pan-sensitive K. pneumoniae, and abdominal ultrasound detected a liver abscess, leading to the diagnosis of IKPLAS. Doppler ultrasound revealed hepatic vein thrombi and a suspected retrohepatic IVC thrombus. She was transferred to our hospital for further management. At our hospital, ultrasound-guided percutaneous catheter drainage of the abscess was performed (pus culture confirmed K. pneumoniae). Subsequently, interventional treatment was performed: an 18 mm × 60 mm PTA dilatation catheter was inflated to prevent bacterial embolus detachment; then a 10F peripheral thrombectomy catheter was used for repeated aspiration, successfully retrieving white massive/filamentous bacterial emboli. Final venography showed complete resolution of the IVC filling defect, restored patency, and no perioperative complications. The patient received a total of 6 weeks of antimicrobial therapy and 3 months of oral rivaroxaban post-discharge. Follow-up at 6 months and 1 year showed complete resolution of all lesions with no recurrence. CONCLUSION: We describe a case of successful interventional treatment (balloon dilation combined with catheter aspiration thrombectomy) for this condition. Interventional therapy may be an effective adjunct to antibiotic and anticoagulation therapy for IKPLAS-related IVC bacterial embolism.