Abstract Introduction Hypermucoviscous Klebsiella (hvKP) is a relatively new hypervirulent strain that was first noted in the Pacific Rim in the Asian population. Though a gram-negative rod, it can affect multiple organs through hematogenous spread. These “sticky” infections significantly increase mortality in relatively healthy patients. Commonly, the diagnostic test for hvKP is string testing. Case Description Our 46-year-old male with a history of insulin dependent type 2 diabetes presented from home for nausea, vomiting, and hyperglycemia. On arrival, he was tachycardic and tachypneic but at baseline mental status. Labs notable for high anion gap metabolic acidosis with glucometer readings 600 mg/dL. Initially he was admitted to MICU for DKA management. Despite appropriate therapy including insulin infusion, the patient became acutely altered and hypoxic. The patient was emergently intubated for respiratory failure that was complicated by wide complex sinus tachycardia. Subsequently after intubation, the patient had increasing pressor requirements, requiring levophed, epinephrine, vasopressin, and hydrocortisone. CT chest showed bilateral lung multifocal consolidations/opacifications. Infectious work up revealed Klebsiella pneumoniae bacteremia, likely source being from the lungs. Further analysis grew hvKP strains diagnosed by string testing. Initial imaging studies looking for satellite lesions showed no metastatic lesions, but the patient’s course was further complicated by witnessed seizures. MRI brain with and without contrast revealed a single subcentimeter right centrum centrum semiovale ring-enhancing nodule. Lumbar puncture was negative for meningitis and encephalitis. The patient was maintained on meropenem and showed improvement without further seizure activity and was extubated. The remainder of his course was uncomplicated and was discharged with antibiotics. Discussion HvKP has now been documented in increasing rates in Western countries and has been especially common within Asian communities. Consideration for metastatic lesions is important to ensure that there are no other sites that may need more source control beyond antibiotics, as some cases have required drainage or even eye enucleation. In previous cases, hvKP can cause remote reinfection that may indicate the need for long term surveillance. Our patient presented as a case of DKA triggered by septic shock from pneumonia but then led to a complicated course with new onset seizures. When evaluating for satellite lesions after hvKP was isolated, CT imaging was not enough to detect a satellite abscess and required MRI. More research would increase awareness, create better diagnostic testing to further evaluate the strain of klebsiella and potentially understand why hvKP infects Asian patients. This abstract is funded by: None
Zhao et al. (Fri,) studied this question.