Cerebral venous sinus thrombosis secondary to nasopharyngeal abscess with Klebsiella pneumoniae infection in an elderly patient with multiple comorbidities: a case report and literature review

BACKGROUND: Cerebral venous sinus thrombosis (CVST) is a rare but severe cerebrovascular disorder. While often associated with hypercoagulable states, infections, particularly those involving the head and neck region, can be a significant predisposing factor. Klebsiella pneumoniae is a known pathogen causing invasive syndromes, including liver abscesses and metastatic infections, but its association with nasopharyngeal abscess leading to CVST and cavernous sinus syndrome is exceptionally rare, especially in elderly patients with complex medical backgrounds. CASE PRESENTATION: We report the case of a 77-year-old Chinese male with a history of hypertension and type 2 diabetes (poorly controlled), who presented with a 27-day history of paroxysmal headache and 10 days of progressive lethargy and gait instability. He subsequently developed bilateral eyelid ptosis, eyelid edema, chemosis, and ophthalmoplegia. Imaging studies identified a nasopharyngeal abscess with associated cavernous sinus thrombosis. Microbiological analysis of nasopharyngeal abscess fluid and blood targeted next-generation sequencing (tNGS) confirmed Klebsiella pneumoniae as the causative organism. The patient was managed with a multidisciplinary approach involving prolonged intravenous antibiotic therapy (Initially, meropenem and teicoplanin were administered; subsequently, the antibiotics were switched to levofloxacin and piperacillin-tazobactam based on the results of antimicrobial susceptibility testing), anticoagulation, intensive glycemic and blood pressure control, and nutritional support. After a 22-day hospitalization, his symptoms significantly improved, inflammatory markers normalized, and he was discharged on a 4-6 week course of oral antibiotics (levofloxacin and cefixime) CONCLUSION: This case highlights a rare life-threatening complication of Klebsiella pneumoniae-induced nasopharyngeal abscess progressing to septic cavernous sinus thrombosis and cavernous sinus syndrome in an elderly immunocompromised patient with diabetes. It underscores the importance of considering invasive Klebsiella pneumoniae infection in the differential diagnosis of cranial neuropathies and CVST, particularly in patients with poor glycemic control. Early recognition, aggressive antimicrobial therapy, and anticoagulation are crucial for favorable outcomes.