Klebsiella pneumoniae peripheral lymphadenitis: A rare presentation

Abstract A 64-year-old male patient presented with a history of fever for 2 days and swelling over the right side of the neck for the past 4 days. He was known to have type 2 diabetes mellitus for the past 5 years and essential hypertension for the past 3 years and was receiving treatment for the same. A general physical examination revealed a pulse of 100 beats/min, blood pressure 140/90 mmHg and he was afebrile. A 10 cm × 8 cm, warm, erythematous swelling was found over the right side of the neck close to the angle of the mandible. Laboratory investigations revealed leucocytosis (12,100/mm 3 ) and glycosylated haemoglobin (HbA 1c ) at 12.7%. Ultrasonography (USG) and contrast-enhanced computed tomography of the neck showed right level II necrotic lymph nodes (LNs) with focal breach and adjacent minimal collection. The patient was hospitalised and started on iv ceftriaxone. LN aspirate revealed frank pus that tested negative on Xpert MTB/RIF; bacterial culture and drug-susceptibility testing had revealed Klebsiella pneumoniae sensitive to ceftriaxone amongst others. Glycaemic control was optimised. After 5 days, iv ceftriaxone was switched to oral cefpodoxime that was administered for 7 days. At the follow-up visit 10 days after discharge, the swelling had considerably regressed in size; repeat USG of the neck showed a significant decrease in the size of the enlarged LNs with a reduction in skin and subcutaneous inflammation. At 3-month follow-up after discharge, residual lymphadenopathy was not evident, HbA 1c came down to 6.9% and the patient was doing well on follow-up. The present case highlights the rare occurrence of peripheral lymphadenitis due to K. pneumoniae .