Disseminated Klebsiella pneumoniae Infection Causing Multisystem Abscesses and Necrotising Fasciitis in an Immunocompetent Patient: A Case Report.
- 1Department of Emergency Medicine Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University) Changsha Hunan China hunnu.edu.cn.
Abstract
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. 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. 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.
Related
- Community-Acquired Klebsiella pneumoniae Meningitis With Liver Abscess and Neurological Sequelae in an Immunocompetent Adult: A Case Report
- Cytomegalovirus-associated Disseminated Intravascular Coagulation in an Immunocompetent Patient: A Case Report and Literature Review
- Severe Inflammatory Response and Moderate Acute Respiratory Distress Syndrome (ARDS) in an Immunocompetent Patient With Disseminated Tuberculosis: A Case Report.
- Cardiac Tamponade Secondary to Streptococcus pneumoniae-Associated Purulent Pericardial Effusion in an Immunocompetent Young Adult With Heavy Tobacco Exposure.
- Hypervirulent Klebsiella pneumoniae Infections in Vancouver, Canada: A Clinical, Microbiological, and Genetic Retrospective Investigation
BibTeX
@article{yi2026disseminated,
title = {{Disseminated Klebsiella pneumoniae Infection Causing Multisystem Abscesses and Necrotising Fasciitis in an Immunocompetent Patient: A Case Report.}},
author = {Qi Yi and Ying Huang and Huanxin Cao and Xingwen Zhang},
journal = {Case reports in infectious diseases},
year = {2026},
month = oct,
doi = {10.1155/crdi/5938248},
url = {https://europepmc.org/article/MED/42953434},
note = {CC BY},
}
RIS
TY - JOUR
TI - Disseminated Klebsiella pneumoniae Infection Causing Multisystem Abscesses and Necrotising Fasciitis in an Immunocompetent Patient: A Case Report.
AU - Qi Yi
AU - Ying Huang
AU - Huanxin Cao
AU - Xingwen Zhang
PY - 2026
DA - 2026/10/28
JO - Case reports in infectious diseases
DO - 10.1155/crdi/5938248
UR - https://europepmc.org/article/MED/42953434
AB - 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. 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. 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.
SN - 2090-6625
SN - 2090-6633
ER -