Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran.
J Med Case Rep. 2024 Jul 14;18(1):320. doi: 10.1186/s13256-024-04653-6.
Metastatic brain abscesses caused by Klebsiella pneumoniae are extremely rare but life-threatening conditions. To depict a unique case of the middle-aged hypertensive man with an unusual presentation of metastatic brain abscesses originating from a pleural abscess caused by Klebsiella pneumoniae and subsequently leading to loss of consciousness (LOC).
A 52-year-old Iranian man with a history of hypertension presented to the emergency department with a five-day history of worsening cough, high-grade fever, shortness of breath, chest pain, fatigue, and a productive cough. Laboratory tests revealed leukocytosis, elevated C-reactive protein, and respiratory alkalosis. A chest computed tomography scan confirmed pneumonia, and a brain scan revealed multiple hypodense lesions. Despite antibiotic therapy, the patient's condition worsened, leading to confusion, disorientation, and loss of consciousness. Magnetic resonance imaging revealed multiple ring-enhancing lesions, suggesting an abscess formation. Bronchial washings and BAL samples confirmed a lower respiratory tract infection. Cultures from the bronchial washings grew Klebsiella pneumoniae.
Metastatic brain abscesses caused by Klebsiella pneumoniae are exceedingly rare but life-threatening conditions. Timely diagnosis and effective antimicrobial treatment are critical for patient outcomes. This case underscores the significance of recognizing atypical presentations of bacterial infections, as early detection and appropriate management can significantly impact patient outcomes.
由肺炎克雷伯菌引起的转移性脑脓肿极为罕见，但危及生命。本文报告了一例中年高血压患者，其表现不典型，由肺炎克雷伯菌引起的脓胸脓肿转移至脑，进而导致意识丧失（LOC）。
一名 52 岁的伊朗男性，有高血压病史，因五天来咳嗽加重、高热、呼吸急促、胸痛、乏力和咳痰就诊于急诊科。实验室检查显示白细胞增多、C 反应蛋白升高和呼吸性碱中毒。胸部 CT 扫描证实为肺炎，脑部扫描显示多个低密病灶。尽管给予抗生素治疗，患者病情仍恶化，出现意识混乱、定向障碍和意识丧失。磁共振成像显示多个环形增强病灶，提示脓肿形成。支气管灌洗和 BAL 样本证实下呼吸道感染。支气管灌洗液培养出肺炎克雷伯菌。
由肺炎克雷伯菌引起的转移性脑脓肿极为罕见，但危及生命。及时诊断和有效的抗菌治疗对患者预后至关重要。本病例强调了认识细菌感染不典型表现的重要性，早期发现和适当的管理可以显著影响患者的预后。
