Hypermucoviscous Klebsiella pneumoniae presenting as sternocleidomastoid pyomyositis with subsequent lower extremity necrotising fasciitis.

IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL
Julia Margaret Dambly, Emily R Hunter, Alec M Giakas, Joseph B Glowacki
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引用次数: 0

Abstract

Necrotising fasciitis (NF) is a severe, rapidly progressing infection of the muscular fascia and subcutaneous tissue. Monomicrobial NF from hypermucoviscous Klebsiella pneumoniae (hvKP-NF) is rare but highly virulent, most common in East Asia. This report reviews a unique case of hvKP-NF in a US male in his 40s with undiagnosed diabetes mellitus, presenting with severe sepsis, neck swelling and calf pain. Imaging revealed pyomyositis in the sternocleidomastoid, and debridement cultures confirmed hvKP. Despite unremarkable examination findings, persistent pain led to a diagnosis of necrotising fasciitis after initial imaging misinterpretations. The patient was treated with multiple surgical debridements and tailored antibiotics. This case underscores the importance of maintaining a high index of suspicion for necrotising fasciitis despite atypical risk factors and symptomatology, awareness of hvKP in the Western Hemisphere, prompt consideration of advanced imaging modalities when initial evaluations are inconclusive and the critical role of multidisciplinary care in managing severe infections.

高粘滞肺炎克雷伯菌表现为胸锁乳突肌化脓性炎,并发下肢坏死性筋膜炎。
坏死性筋膜炎(NF)是一种严重的、进展迅速的肌肉筋膜和皮下组织感染。来自高黏稠肺炎克雷伯菌(hvKP-NF)的单微生物NF是罕见的,但毒性很强,最常见于东亚。本报告回顾了一例独特的hvKP-NF病例,患者为40多岁的美国男性,伴有未确诊的糖尿病,表现为严重的败血症、颈部肿胀和小腿疼痛。影像显示胸锁乳突肌炎,清创培养证实hvKP。尽管检查结果不显著,持续疼痛导致诊断坏死性筋膜炎后,最初的影像误解。患者接受多次手术清创和量身定制的抗生素治疗。该病例强调了对坏死性筋膜炎保持高度怀疑的重要性,尽管存在非典型的危险因素和症状,西半球对hvKP的认识,在初步评估不确定时及时考虑先进的成像方式,以及多学科护理在管理严重感染中的关键作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Case Reports
BMJ Case Reports Medicine-Medicine (all)
CiteScore
1.40
自引率
0.00%
发文量
1588
期刊介绍: BMJ Case Reports is an important educational resource offering a high volume of cases in all disciplines so that healthcare professionals, researchers and others can easily find clinically important information on common and rare conditions. All articles are peer reviewed and copy edited before publication. BMJ Case Reports is not an edition or supplement of the BMJ.
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