Fulminant Klebsiella pneumoniae Meningitis in a Patient with Type 2 Diabetes Mellitus: A Case Report

Abstract

Introduction: Klebsiella pneumoniae meningitis represents an acute pyogenic infection of the subarachnoid space with concurrent inflammation of the central nervous system. Case Presentation: A 47-year-old male agricultural worker with poorly controlled type 2 diabetes mellitus on irregular oral hypoglycemic therapy presented with altered consciousness. Clinical examination revealed pain localization with eye opening, divergent gaze, nuchal rigidity, bilateral positive Babinski signs, and Kussmaul breathing. Initial blood glucose was 480 mg/dL. Plain and contrast-enhanced computed tomography demonstrated punctate hypodense frontal lesions suggestive of infectious vasculitis and cerebral edema without abscess formation. Treatment was initiated with cefepime 2 g every 8 hours, vancomycin 1.5 g every 12 hours, and ampicillin 2 g every 4 hours. The patient rapidly developed multiple organ failure, subsequently experienced cardiac arrest with asystole, and died. Conclusions: K. pneumoniae meningitis typically presents with an accelerated and aggressive clinical course, necessitating prompt therapeutic intervention. This diagnosis should be considered in patients with underlying conditions, particularly in those with urinary tract infections presenting with fever and altered mental status.

Keywords

• bacterial meningitis
• k. pneumoniae
• shock
• septic
• spinal puncture