Disseminated Klebsiella pneumoniae Infection Causing Multisystem Abscesses and Necrotising Fasciitis in an Immunocompetent Patient: A Case Report
Qi Yi, Ying Huang, Huanxin Cao, Xingwen ZhangBackground
Disseminated Klebsiella pneumoniae infection that concurrently produces a liver abscess, bilateral pulmonary abscesses and necrotising fasciitis is uncommon in patients without overt immunocompromise. Definitive designation of a hypervirulent strain requires the string test and virulence‐gene testing, which are not always available at the point of care.
Case Presentation
A previously healthy 48‐year‐old man, in whom a contaminated lower limb wound was the suspected portal of entry, subsequently developed a liver abscess, multiple bilateral pulmonary abscesses, necrotising soft‐tissue infection of the left lower limb and sepsis with circulatory instability. Culture of the liver‐abscess aspirate yielded a mucoid K. pneumoniae that was susceptible to carbapenems, ceftazidime/avibactam, amikacin and levofloxacin, among other agents. Because neither the string test nor virulence genes (e.g., rmpA , iucA ) were examined, the isolate was described only as having a clinically hypervirulent phenotype based on mucoid colony morphology and the multisite invasive pattern. Stenotrophomonas maltophilia and multidrug‐resistant Acinetobacter baumannii were recovered sequentially from bronchoalveolar lavage fluid and sputum and were interpreted, in context, as airway colonisation or ventilator‐associated tracheobronchitis. After multisite percutaneous drainage, repeated debridement with vacuum sealing drainage, staged antimicrobial therapy and organ support, the patient recovered and was discharged; at the 3‐month follow‐up, the lesions had largely resolved without recurrence.
Conclusion
This case suggests that multisite metastatic abscesses in an immunocompetent individual should raise suspicion for invasive K. pneumoniae infection. Early, adequate source control together with rational antimicrobial stewardship appears central to a favourable outcome. The conclusions are limited by the single‐case design and the absence of molecular confirmation of hypervirulence.