HYPER, a case report
20 something years old man of Asian descent presented with a history of 1 week of temperatures, retrosternal chest pains and just not doing that hot. COVID test was negative.
During his physical, I could tell he was sick, pale, sweaty, tachypneic and tachycardic. His pressure was normal. Meningeal signs are negative. Neuro negative. Abdomen negative. No peripheral signs of emboli or rashes. There was a bit of a weird chest sound (listed I have been doing ID for some years but for the life of me sometimes I can't tell which one it is...I just know it's not supposed to be there)) and I think I heard a heart mummer.
His labs: high white cell count, elevated CRP and procalcitonin. In the differential, neutrophils took the prize. Lactate thru the roof. Liver enzymes were elevated (transaminases).
He got a chest x-ray which was clear. Ultrasonography of the abdomen was negative.
His history was insignificant, he doesn't have any preexisting medical conditions, and he is updated on all his vaccinations. He is straight, married for a few years. He likes to play football with his friends who are all of Asian descent. They don't have kids but they have a dog. He is a teacher, he teaches English. He hasn't been to his country of origin since he was a child and nobody around him has travelled anywhere lately. He doesn't travel, he hates flying.
I admitted him and started him on co-amoxicillin with metronidazole bc all I had was tachypnoea and fevers. Tho his chest x-ray was negative, we decided to order a chest and abdomen CT scan, his ddimeres were elevated so I wanted to make sure he doesn't have a PE, which he did not. However, what the CT scan described - was 2 small abscesses peripherally liver approximately 3cm each.
Meanwhile, his blood cultures came back positive for...
GIF by thegalaxyrailways
Klebsiella pneumoniae, the hypervirulent kind
lol
ok. I wanted to prescribe cefta+avibactam. My boss laughed and laughed and laughed and asked from which pocket that will go so...
In the end, we did a CT navigated drainage and gave him colistin.
He did well.
But I think it's something he got from the community. At least it's what the lit says.
Do u have any experience with hypervirulent Klebsiella pneumonia infection? Drop a msg in my inbox I wanna hear all your tips and tricks!
Also, I hope all my ID folks are having the best time at ID week. I hope I will be able to go one day!
