A49-13 Fatal Klebsiella Pneumoniae Meningitis in a Patient With Diabetes Mellitus

Abstract Introduction Klebsiella pneumoniae meningitis is typically seen in hospital settings, especially in patients who have recently undergone neurosurgery. In the United States, cases that develop outside the hospital are rare. This case report highlights an unusual cause of meningitis Klebsiella pneumoniae by exploring who is most at risk, what factors influence outcomes, and why early recognition matters. Prompt diagnosis and starting the right antibiotics as soon as possible can make a crucial difference in recovery, underscoring the need for clinicians to consider this pathogen even when it is not the most common cause. Case Report A 36-year-old man with diabetes was found unresponsive at home and rushed to the emergency department. He arrived in critical condition, breathing in deep Kussmaul respirations, and was immediately intubated. He was tachycardic, tachypneic, and hypothermic. A head CT showed no acute bleed but did note fluid in the right mastoid. Labs confirmed severe diabetic ketoacidosis, and he was started on aggressive fluids and broad-spectrum antibiotics for suspected sepsis. By the next day, his condition worsened into septic shock, requiring multiple escalating vasopressors. Repeat imaging revealed worsening brain swelling, signs of shock bowel, and an inflamed, stone-free gallbladder; due to concern for acalculous cholecystitis, a percutaneous cholecystostomy tube was placed by interventional radiology. A lumbar puncture showed very high opening pressure and cloudy yellow cerebrospinal fluid, so antimicrobials were broadened to acyclovir, ampicillin, metronidazole, cefepime, and vancomycin. Cerebrospinal fluid studies demonstrated a very high white blood cell count, very low glucose, and high protein, findings consistent with bacterial meningitis. Despite maximal support, he did not regain responsiveness. MRI revealed diffuse cortical infarction and global anoxic brain injury with severe cerebral edema and effacement of the sulci and basal cisterns. EEG showed no electrical activity. Although formal brain death testing was initially limited by a ruptured eardrum that prevented vestibulo-ocular testing, a cerebral blood flow study ultimately confirmed findings consistent with brain death. Discussion Bacterial meningitis remains a dangerous illness, carrying a high risk of complications and death even with modern antibiotics and advanced supportive care. In fact, studies show that more than half of patients with Klebsiella pneumoniae meningitis may not survive despite receiving appropriate therapy. Diabetes can make people more vulnerable by causing blood vessel changes that allow K. pneumoniae to spread through the bloodstream more easily. In our patient, this likely contributed to the infection’s hematogenous spread, given his history of diabetes. This abstract is funded by: none