Multiple brain abscesses due to hypervirulent Klebsiella pneumoniae: A case report and literature review

Abstract Hypervirulent Klebsiella ( K .) pneumoniae has emerged as the most clinically important pathogen causing liver abscess with metastatic infections at other body sites. We reported a case of multiple brain abscesses due to hypervirulent K . pneumoniae in a 55-year old woman undergoing treatment for endophthalmitis. The patient was admitted to our hospital because of toothache, shivering, fever, loss of vision and headache for 8 days. Ocular ultrasound revealed endogenous endophthalmitis. The body temperature did not return noram after routine intravenous anti-infective treatment. Vitrectomy was performed and both eyes were filled with liquid silicone. Norvancomycin plus ceftazidime and dexamethasone were injected intraocularly. Meanwhile, intravenous amikacin/sulbactam was administered. Vitreous fluid smear showed Gram negative bacteria. Fosfomycin was added. MALDI-TOF MS identified the bacteria to be K. pneumoniae . Drug sensitivity test showed that K. pneumoniae had high sensitivity to common antibiotics. The presence of virulence genes rmpA and rmpA2 confirmed that the strain was hypervirulent K. pneumoniae . The body temperature returned to normal. No pus was present and the patient had light perception in both eyes. Repeat CT showed that the lung lesion became smaller compared with earlier result. But cerebral MRI revealed multiple brain abscesses. The anti-infective regimen was adjusted to levofloxacin plus ceftazidime. Repeat head MRI showed that the lesions became smaller. After six months, the patient was discharged and remained free from recurrence. In conclusion, our case indicates that patients with invasive syndrome caused by hypervirulent K. pneumoniae should undergo repeated examinations of possible invasive sites and physicians should be watchful of delayed development of brain abscess.