Extensive disseminated brain abscess caused by hypervirulent Klebsiella pneumoniae: case report and literature review

Klebsiella pneumoniae (KP), particularly its hypervirulent strain (hvKP), is primarily associated with hospital-acquired infections. hvKP is considered an uncommon cause of brain abscesses in adults, and community-acquired brain abscesses caused by hvKPs are rare. We report a rare case of an adult patient with an invasive cerebral abscess with extensive cranial dissemination linked to hvKP and review the relevant literature. A 58-year-old male was admitted to hospital with fever and headache reported for the previous two days. Upon admission, the patient developed septic shock and was drowsy, with neck stiffness and a positive Kernig’s sign. Initial brain computed tomography showed no significant abnormalities, but cerebrospinal fluid analysis showed increased white blood cell counts and protein levels, as well as reduced glucose concentration. Cultures of cerebrospinal fluid and blood yielded KP, and high-throughput gene sequencing of the pathogen identified it as hvKP. Magnetic resonance imaging revealed extensive scattered lesions in the supratentorial and subtentorial regions on both sides of the brain. The patient’s condition gradually improved after treatment with meropenem, vancomycin, and metronidazole. Multiple brain magnetic resonance imaging scans performed 6 months after discharge showed gradual improvement in the lesions, and the patient recovered well. Adults with compromised immune systems may develop community-acquired, invasive, and disseminated hvKP brain abscesses. Early cerebrospinal fluid analysis and blood cultures are crucial for an accurate diagnosis, and high-throughput sequencing can aid in the identification of pathogen subtypes. Therefore, future genomic and translational studies are required to develop targeted treatments.