Intramedullary spinal cord abscess due to disseminated hypermucoviscous Klebsiella pneumoniae infection: A rare case report

Abstract

Background: Intramedullary spinal cord abscess (ISCA) is a rare and serious condition with high disability and mortality rates. Klebsiella pneumoniae (K. pneumoniae) is known for its aggressive and disseminated abscess formation. However, ISCA caused by K. pneumoniae has only been reported in two cases. Additionally, there have been no documented instances of K. pneumoniae invasive syndrome with abscesses in the brain, intramedullary spinal cord, renal subcapsular, and prostate simultaneously. Case presentation: A 58-year-old man with poorly controlled type 2 diabetes presented with a 4-day history of fever, fatigue and loss of appetite, accompanied by urinary frequency and urgency. A contrast computed tomography (CT) scan of the chest, abdomen, and pelvis revealed abscesses in multiple organs including the lung, renal subcapsular, and prostate. Over following 8 days, the patient experienced with urodynia, back pain, dysuria and bilateral lower limb weakness. Subsequent magnetic resonance imaging (MRI) of the brain and spinal also showed multiple abscesses. Cultures of blood, urine, and pus from the prostate abscesses grew K. pneumoniae, characterized by the hypermucoviscous phenotype, as confirmed by the string test. After treatment with imipenem/cilastatin, amikacin, and a period of rehabilitation, the patient was discharged in good health. Conclusion: This case emphasizes the need to consider ISCA in disseminated hmKp infection patients with back pain and neurological deficits. Timely identification and antibiotic treatment may obviate the need for surgical intervention.

Keywords

• Intramedullary spinal cord
• Renal subcapsular
• Prostate
• Abscess
• Klebsiella pneumoniae