Disseminated Klebsiella pneumoniae Meningitis in Uncontrolled Diabetes: A Rare Virulent Infection

Introduction: Klebsiella pneumoniae meningitis is a rare but severe gram-negative infection. Our case report highlights a 44 year old male with uncontrolled diabetes who was diagnosed with rapidly progressive form of meningitis with a distinctive clinical course.


Description: A 44-year-old male with type 2 diabetes presented with altered mental status and hyperglycemia (800 mg/dL), leading to a diagnosis of hyperglycemic crisis. Despite initial treatment, his condition worsened with persistent fever, disorientation and new-onset seizures, raising suspicion for meningitis. Empiric antimicrobial regimen and steroids initiated.
A lumbar puncture confirmed bacterial meningitis (WBC 2700 cells/mm³ and elevated protein). Pan CT scans revealed a hepatic abscess and bilateral pneumonia. CSF culture, urine culture and hepatic abscess aspirate grew Klebsiella pneumoniae, confirming a disseminated infection. Blood cultures were negative. The antimicrobial regimen was adjusted to ceftriaxone, metronidazole, and levofloxacin. Hyperinfection with strongyloides stercoralis was tested for but ultimately ruled out. The patient's condition was complicated by acute kidney injury, thrombocytopenia and acute hypoxic respiratory failure due to sepsis, and he later required thoracic surgery (VATS with decortication) for persistent loculated empyema. After a prolonged hospitalization, he made a full recovery with normalized mentation and hemodynamic stability. He was discharged on oral levofloxacin and supplemental oxygen.


Discussion: Klebsiella pneumoniae has unique pattern of spread and can cause both healthcare-associated and community-acquired meningitis, associated with hypervirulent strains and invasive syndromes such as liver abscess with metastatic CNS involvement, particularly in patients with diabetes or immunocompromise. Hypervirulent strains can cause severe, rapidly progressive disease with high rates of mortality up to (45–50%) . Therefore, strong infection control and increased clinical vigilance are crucial in light of the emergence of multidrug-resistant hypervirulent strains.