Community-acquired hypervirulent Klebsiella pneumoniae meningitis in Canada: A case report.

INTRODUCTION

Hypervirulent Klebsiella pneumoniae has emerged as a cause of fulminant metastatic infections, particularly prevalent amongst patients in Asia, but increasing in many areas worldwide. This report describes a fatal case of community-acquired Klebsiella pneumoniae in Canada causing meningitis complicated by several neurological complications.

CASE PRESENTATION: A 58-year-old male with a long-standing history of poorly controlled type two diabetes mellitus presented with a two-day history of confusion, fatigue, and fall. He was febrile and tachycardic, and had laboratory findings consistent with diabetic ketoacidosis. Despite initial broad-spectrum antimicrobials, he deteriorated neurologically, prompting intubation. Lumbar puncture yielded frankly purulent cerebral spinal fluid (CSF), and both blood and CSF cultures grew Klebsiella pneumoniae sensitive to Ceftriaxone. Brain imaging revealed leptomeningeal inflammation, ventriculitis, and non-occlusive thrombi of the right internal jugular vein and superior sagittal sinus. A liver abscess was also discovered, a finding commonly reported with hypervirulent Klebsiella pneumoniae infections. Anticoagulation was initiated while balancing the risk of intracranial hemorrhage. Despite aggressive critical care measures, repeat imaging demonstrated diffuse cerebral edema with evolving global anoxic injury. A nuclear medicine cerebral perfusion scan showed absent cerebral blood flow, and goals of care were transitioned to comfort measures. The patient passed away shortly thereafter.

CONCLUSION

This case highlights the rapid progression and complexity of hypervirulent Klebsiella pneumoniae. Metastatic sites of infection and antimicrobial resistance should be considered and may alter management, including antibiotic choice and percutaneous drainage of silent sites of infection.