SHM Converge Scientific Abstract ePoster Gallery-Klebsiella Pneumoniae Meningitis Resulting From Untreated Bacteremia and Vitreous Hemorrhage

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This case describes a 51-year-old woman with end-stage renal disease on hemodialysis who presented two days after pars plana vitrectomy with severe bilateral eye pain, headache, fever, and encephalopathy. Although she was found to have left acute angle-closure glaucoma and underwent anterior chamber paracentesis, her mental status changes were out of proportion to the eye findings, prompting a broader infectious workup.<br /><br />She had been hospitalized one month earlier for Klebsiella bacteremia due to pyelonephritis and was discharged on levofloxacin, but her tunneled hemodialysis line had not been removed. On admission, she was started empirically on meningitis coverage with vancomycin, ceftriaxone, and ampicillin. Blood cultures later grew Klebsiella pneumoniae, and the dialysis line was removed. Lumbar puncture showed marked neutrophilic pleocytosis, elevated protein, and findings consistent with bacterial meningitis, though CSF cultures and a meningitis panel were negative.<br /><br />Despite ongoing encephalopathy, MRI of the brain on hospital days 4–6 revealed multiple acute cortical and subcortical infarcts in both hemispheres, consistent with shower emboli, likely related to a septic process. TTE and TEE were negative for endocarditis. She completed a 14-day course of ceftriaxone for presumed Klebsiella meningitis and recovered fully with resolution of encephalopathy.<br /><br />The case highlights that community-acquired Klebsiella pneumoniae meningitis is rare but highly morbid, and may occur in patients with prior Klebsiella infections or inadequately controlled bacteremia. Early recognition and prompt antibiotic treatment are critical to prevent neurologic deterioration.

Asset Subtitle

Minami Katie YAMAMURA

Meta Tag

Author List Minami Katie YAMAMURA

Category Clinical Vignettes

Concept Klebsiella pneumoniae meningitis

Concept Empiric Antibiotic Therapy

Concept Encephalopathy

Concept Bacteremia

Concept Acute Bacterial Meningitis

Distinguished Non-Finalist

Presenter Organization University of Colorado, School of Medicine

Presenting Author Minami Katie YAMAMURA

Track Adult

Keywords

Klebsiella pneumoniae

bacterial meningitis

hemodialysis

encephalopathy

septic emboli

acute angle-closure glaucoma

lumbar puncture

blood culture

ceftriaxone

end-stage renal disease

Klebsiella pneumoniae meningitis

Empiric Antibiotic Therapy

Encephalopathy

Bacteremia

Acute Bacterial Meningitis