Klebsiella pneumoniae pneumonia with neck infection and septic thrombosis

Case contributed by Dr Maria Grazia Papi

Presentation

Fever, productive cough and a lesion within the superficial soft tissue of the neck likely of inflammatory origin.

Patient Data

Age: 50 years
Gender: Female
X-ray

Chest x-ray (on admission)

Bibasal small airways opacification. Blunting of the left costophrenic angle.

Bilateral pneumonic consolidation with a random distribution associated with small low-density areas, with ground-glass attenuation, extensive bronchial wall thickening, and interlobular septal thickening.

Enhanced CT of the neck demonstrated necrotic, colliquative areas delimited by an enhanced border, within the soft tissue of the posterior left lateral aspect of the neck. An intraluminal filling defect within the left internal jugular vein is in keeping with septic thrombus.

Eight days after admission to the hospital there is evidence of disease progression with a new finding of cavitation superimposed to the lung consolidations with worsening of the centrilobular nodules, bronchial wall thickening and the ground glass attenuations. Bilateral pleural effusions visible.

Annotated image

Interval imaging comparison of CT chest studies (day 3 and day 8)

Interval comparison between the first (3 days after admission) and the second (8 days after admission) CT chest studies, at same imaging level: there is evidence of progressive cavitation within previous lung consolidation, suggesting necrotizing pneumonia (red arrows).

Rapid progression of the disease. Widespread small airways opacification bilaterally. In the right middle-lower zone, there is evidence of lung consolidation associated with lucent areas likely represeting cavitation.

Microculture sensitivities from bronchoalveolar lavage and central line tip samples positive for Klebsiella pneumoniae.

Case Discussion

Accordingly with other scientific studies, in this case of Klebsiella pneumoniae pneumonia (KPP) (combined with concurrent infections) a dramatic onset and a progressive worsening of the respiratory conditions and of the radiologic findings in spite of the prompt diagnosis and therapy occurred. In the last stage, the radiological features were of acute respiratory distress syndrome (ARDS) with pulmonary edema.

In this patient, a particular pattern of KP infection spreading from an inflammatory lesion of the neck soft tissue through a septic thrombosis of the IJV to the lungs has been hypothesized. The CTs and plain radiographs of the chest resembled those described in other scientific works with the main features of this lung infection being superimposed cavitation on the previous consolidation, suggesting necrotizing pneumonia, associated with pleural abnormalities and poorly confined lung infiltrates.

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Case information

rID: 34960
Published: 11th Dec 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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