Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California, 2020 Zonal Ave, IRD 723, Los Angeles, CA, 90033, USA.
Department of Internal Medicine, University of Southern California, Los Angeles, California, USA.
J Med Case Rep. 2021 Feb 4;15(1):44. doi: 10.1186/s13256-020-02633-0.
Klebsiella pneumoniae brain abscesses are a rare entity and typically present in immunocompromised patients. We present a case of an overall healthy patient who developed a Klebsiella pneumoniae brain abscess in the absence of liver pathology.
A 46-year-old Vietnamese man with past medical history significant for hypertension presented to the hospital with acute on chronic worsening of altered mental status, personality changes, and gait dysfunction. Initial vitals revealed temperature of 37.1 °C, heart rate 87 beats/minute, blood pressure 150/87 mmHg, respiratory rate 18/minute, and oxygen saturation 99% on room air. Physical exam was notable for altered mental status, Glasgow Coma Scale (GCS) score of 14, and right lower facial droop. Cardiopulmonary exam was within normal limits. Head computed tomography (CT) showed a left frontotemporal mass, with subsequent brain magnetic resonance imaging (MRI) revealing a ring-enhancing lesion concerning for a brain abscess. The abscess was urgently drained; however, there was intraoperative spillage into the ventricles. Intraoperative cultures grew Klebsiella pneumoniae, and the patient was maintained on appropriate antibiotics. He developed worsening mental status, septic shock, and cerebral edema requiring decompressive left hemicraniectomy. Computed tomography of the abdomen and pelvis revealed no hepatic lesions. The patient did not improve, and the family elected for comfort measures.
High mortality is associated with Klebsiella pneumoniae (as opposed to Klebsiella oxytoca) brain abscesses, especially in the setting of intraventricular spread. This case illustrates the need for early detection, and an aggressive medical and surgical treatment approach is required for a potential favorable outcome.
肺炎克雷伯菌脑脓肿较为罕见，通常发生于免疫功能低下的患者。我们报告了一例无肝病史的免疫功能正常的患者发生肺炎克雷伯菌脑脓肿的病例。
一名 46 岁越南男性，有高血压病史，因慢性精神状态逐渐恶化伴急性发作、人格改变和步态功能障碍而到医院就诊。初始生命体征示体温 37.1°C，心率 87 次/分钟，血压 150/87mmHg，呼吸频率 18 次/分钟，室内空气下血氧饱和度 99%。体格检查示精神状态改变，格拉斯哥昏迷评分（GCS）为 14 分，右侧面下部下垂。心肺检查未见异常。头部计算机断层扫描（CT）显示左额颞部肿块，随后的脑磁共振成像（MRI）显示环形增强病变，考虑脑脓肿。脓肿被紧急引流；然而，术中脓肿内容物溢出到脑室。术中培养出肺炎克雷伯菌，患者持续使用适当的抗生素。他的精神状态恶化，出现感染性休克和脑水肿，需要进行左侧去骨瓣减压术。腹部和骨盆的计算机断层扫描未显示肝脏病变。患者病情未见改善，家属选择采用舒适疗法。
与产酸克雷伯菌（而非肺炎克雷伯菌）脑脓肿相比，肺炎克雷伯菌脑脓肿的死亡率较高，尤其是在发生脑室播散的情况下。本例说明了早期发现的重要性，需要采取积极的医疗和手术治疗方法，以获得潜在的良好预后。
