Positive string test in hypervirulent Klebsiella pneumoniae liver abscess

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Abstract
A 38-year-old diabetic woman presented with fever and jaundice for 4 days. On arrival, she was alert and hemodynamically stable. Physical examination revealed hepatomegaly. An abdominal computed tomography showed a large multiloculated abscess in the right liver lobe without biliary system dilatation ( Fig. 1a). There was no evidence of pneumonia, endophthalmitis or central nervous system involvement. Klebsiella pneumoniae was isolated from the blood culture, which was susceptible to amoxicillin-clavulanic acid and ceftriaxone. String tests on colonies from culture media yielded positive results with strings measuring 7 mm in length ( Fig. 1b). The diagnosis of hypervirulent K. pneumoniae (HvKP) was established following the detection of iuca, rmpA and peg344 gene.