PDF(Pubmed)
Abstract：
BACKGROUND: 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).
METHODS: 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.
CONCLUSIONS: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：肺炎克雷伯菌引起的转移性脑脓肿极为罕见，但危及生命。描述一名中年高血压男子的独特病例，其异常表现为转移性脑脓肿，该脓肿源于肺炎克雷伯菌引起的胸膜脓肿，随后导致意识丧失（LOC）。
方法：一名有高血压病史的52岁伊朗男子到急诊科就诊，有5天咳嗽恶化史，高烧,呼吸急促,胸痛,疲劳,和生产性咳嗽。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.胸部计算机断层扫描扫描证实了肺炎，脑部扫描显示有多处低密度病变.尽管有抗生素治疗,病人的病情恶化了，导致混乱，迷失方向，和失去知觉。磁共振成像显示多个环形增强病变，提示脓肿形成.支气管洗液和BAL样品证实了下呼吸道感染。支气管冲洗液培养出肺炎克雷伯菌。
结论：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。该病例强调了识别细菌感染的非典型表现的重要性，早期发现和适当的管理可以显著影响患者的预后。
方法：一名有高血压病史的52岁伊朗男子到急诊科就诊，有5天咳嗽恶化史，高烧,呼吸急促,胸痛,疲劳,和生产性咳嗽。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.胸部计算机断层扫描扫描证实了肺炎，脑部扫描显示有多处低密度病变.尽管有抗生素治疗,病人的病情恶化了，导致混乱，迷失方向，和失去知觉。磁共振成像显示多个环形增强病变，提示脓肿形成.支气管洗液和BAL样品证实了下呼吸道感染。支气管冲洗液培养出肺炎克雷伯菌。
结论：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。该病例强调了识别细菌感染的非典型表现的重要性，早期发现和适当的管理可以显著影响患者的预后。
