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侵袭性阴沟肠杆菌综合征:一项具有挑战性的诊断。

Klebsiella invasive syndrome: a challenging diagnosis.

机构信息

Internal medicine, Monmouth Medical Center, Long Branch, New Jersey, USA

Internal medicine, Monmouth Medical Center, Long Branch, New Jersey, USA.

出版信息

BMJ Case Rep. 2022 Nov 11;15(11):e251977. doi: 10.1136/bcr-2022-251977.

Abstract

Klebsiella invasive syndrome is a rare condition that typically presents as a liver abscess with metastatic infection, with mortality rates as high as 14% potentially due to diagnostic delay by clinicians. Here, we present a case of a woman in her 60s, who presented with symptoms and signs consistent with meningitis, imaging findings suggestive of possible leptomeningeal carcinomatosis a long with areas of lung consolidation and abdominal nodules and lymphadenopathy, presumably metastatic malignancy. We diagnosed Klebsiella invasive syndrome and treated it conservatively with medical management, including a long course of intravenous antibiotic therapy and supportive care. This is an infrequently encountered clinical entity with potentially fatal consequences, and we hope to add to the existing literature on the subject and drive home the point that it should be considered in the differential diagnoses in the appropriate clinical scenario.

摘要

侵袭性肺炎克雷伯菌综合征是一种罕见的疾病,通常表现为肝脓肿伴转移性感染,由于临床医生的诊断延误,死亡率高达 14%。在这里,我们介绍了一位 60 多岁的女性患者,她的症状和体征符合脑膜炎,影像学检查提示可能存在脑膜癌病,同时还伴有肺部实变、腹部结节和淋巴结肿大,推测为转移性恶性肿瘤。我们诊断为侵袭性肺炎克雷伯菌综合征,并采用保守治疗,包括长期静脉抗生素治疗和支持性护理。这是一种罕见的临床实体,可能导致致命后果,我们希望增加关于该主题的现有文献,并强调在适当的临床情况下应将其纳入鉴别诊断。

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本文引用的文献

1
Invasive Infections in Community-Settings and Healthcare Settings.社区环境和医疗机构中的侵袭性感染
Infect Drug Resist. 2021 Jul 12;14:2647-2656. doi: 10.2147/IDR.S315871. eCollection 2021.
3
[Invasive liver abscess syndrome caused by Klebsiella pneumoniae, case series].
Rev Chilena Infectol. 2020 Nov;37(5):566-569. doi: 10.4067/S0716-10182020000500566.
4
Hypervirulent : Liver Abscess Isolates versus Intestinal Flora.
J Korean Med Sci. 2020 Jan 13;35(2):e28. doi: 10.3346/jkms.2020.35.e28.
5
Metastatic Invasive Liver Abscess Syndrome in Denver, Colorado.科罗拉多州丹佛市的转移性侵袭性肝脓肿综合征
J Pharm Pract. 2021 Apr;34(2):332-336. doi: 10.1177/0897190019882867. Epub 2019 Oct 23.
7
Invasive Klebsiella pneumoniae syndrome.侵袭性肺炎克雷伯菌综合征
QJM. 2019 Nov 1;112(11):878-879. doi: 10.1093/qjmed/hcz092.
8
Invasive Syndrome.侵袭性综合征
Eur J Case Rep Intern Med. 2018 Mar 21;5(3):000800. doi: 10.12890/2018_000800. eCollection 2018.

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