Case Report
Spinal Cord (2009) 47, 345–346; doi:10.1038/sc.2008.141; published online 11 November 2008
A fatal metastasis of Klebsiella pneumoniae to the lungs
J H Frisbie1
1Research Service, Boston Healthcare Center and Harvard Medical School Medicine, Brigham and Womens Hospital, Boston, MA, USA
Correspondence: Dr JH Frisbie, Spinal Cord Injury Service (128), Veterans Administration Hospital, 1400 VFW Parkway, West Roxbury, Boston, MA 02132, USA. E-mail: jfrisbie@comcast.net
Received 23 July 2008; Revised 12 September 2008; Accepted 15 September 2008; Published online 11 November 2008.
Abstract
Background/Objective:
To describe the relationship between a seemingly innocuous colonization in one organ and a fatal infection in another organ in a tetraplegic man.
Design:
Case report.
Source:
Veterans Administration Hospital, USA.
Methods/Results:
A 61-year-old man, paralyzed at C7, American Spinal Injury Association Impairment Scale A for 31 years, presented with cough and negative sputum but urine positive for Klebsiella pneumoniae. After 2 days, he presented with sepsis and hypotension, received fluids and multiple antibiotics (blood and urine cultures taken after antibiotics were negative), and developed pulmonary failure 2 weeks after admission. Bronchial secretions obtained by bronchoscopy for mucous plugging revealed K. pneumoniae. The spectrum of antibiotic sensitivities for the organism from the initial urine and the later bronchial secretions was identical except for resistance to antibiotics administered between cultures. The subject developed an encephalopathy in association with respiratory acidosis, hyponatremia, hypoalbuminemia and renal failure and expired 36 days after presentation.
Conclusion:
The urinary and respiratory tracts were infected with the same organism, leading to fatal sepsis in a chronically paralyzed tetraplegic man, suggesting migration between the two sites.
Keywords:
spinal cord injury, quadriplegia, K. pneumoniae, sepsis, metastatic infection, tetraplegia
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