Invasive Klebsiella Pneumoniae Syndrome Presenting as Leptomeningitis, Ventriculitis, and Vasculitic Infarct Secondary to Pansinusitis in a Diabetic Patient
Jaskaran Singh1, Vipin Kumar2
1Internal Medicine, Dayanand Medical College and Hospital, 2Dayanand Medical College and Hospital
Background:
Invasive Klebsiella pneumoniae Syndrome (IKPS) is a novel hypervirulent variant of K. pneumoniae infection distinguished by the ability to metastasize from the original source, usually in the liver, to distant sites. Involvement of the central nervous system (CNS) is rare and carries grave consequences, in particular when it presents as ventriculitis. We describe a unique case of pansinusitis-associated IKPS with widespread CNS involvement that had a favorable recovery.
Design/Methods:
A 67-year-old female with poorly controlled diabetes mellitus (HbA1c 12.9%) presented to the emergency department with headache and altered level of consciousness (GCS 7). Imaging showed pansinusitis, and the intraoperative pus culture obtained from the functional endoscopic sinus surgery (FESS) identified K. pneumoniae. The MRI brain demonstrated diffuse leptomeningitis, focal pachymeningitis, pyogenic ventriculitis, and a right high parietal vasculitic infarct with hemorrhagic transformation. Cerebrospinal fluid (CSF) cultures also grew K. pneumoniae, consistent with Invasive Klebsiella pneumoniae Syndrome. She was treated with coordinated intravenous antibiotics, neurocritical care and multidisciplinary team-based care, and the patient had full neurological recovery and was discharged without deficits.
Results:
This case demonstrates an unusual manifestation of IKPS from pansinusitis rather than the typical hepatic origin. Direct intracranial extension causing ventriculitis and vasculitic infarction is exceedingly rare. Uncontrolled diabetes likely predisposed to a hypervirulent infection to occur. Early neuroimaging, source control with FESS, and appropriate antimicrobial therapy were all critical to arrive at a good outcome.
Conclusions:
Klebsiella pneumoniae has the potential to produce fastidious central nervous system infections via contiguous extension from the sinuses. Early recognition, surgical source control, and appropriate antibiotic therapy are all essential components of survival and recovery. This rare presentation is one of only a handful of well-documented cases of pansinusitis from Klebsiella pneumoniae infection extending into diffuse leptomeningitis, focal pachymeningitis, ventriculitis, and hemorrhagic vasculitic infarction, successfully treated with complete recovery of neurological function.
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