Klebsiella pneumoniae septic pulmonary embolism from renal vein thrombosis
Abstract
Objectives: To report presumed hypervirulent Klebsiella pneumoniae pyelonephritis causing renal vein-inferior vena cava septic thrombophlebitis, cavitary septic pulmonary emboli, and lung abscesses.
Case presentation: A 47-year-old woman with untreated diabetes presented with urinary symptoms, prolonged fever, abdominal pain, and hypoxemia. Blood and urine cultures yielded K. pneumoniae, with bacteremia persisting despite meropenem. An 11-mm positive string test supported a hypermucoviscous phenotype, although hypervirulence was not genetically confirmed. Computed tomography showed left pyelonephritis, renal abscesses, a near-occlusive renal vein-inferior vena cava thrombus, and bilateral peripheral cavitary pulmonary nodules with pulmonary arterial emboli. Transesophageal echocardiography showed no vegetation.
Management and outcome: Because nephrectomy, thrombectomy, and caval filter placement were considered hazardous, therapy was changed to ceftriaxone at meningitis dosing plus levofloxacin to optimize β-lactam exposure and fluoroquinolone penetration into deep abscesses, with anticoagulation and insulin therapy. Blood cultures cleared by day 7. Pulmonary lesions worsened on day 10, but the thrombus and cavitary lesions regressed by day 38 with continued medical treatment. No recurrent thrombosis was observed on day 207.
Conclusion: Persistent K. pneumoniae bacteremia with cavitary peripheral pulmonary nodules should prompt evaluation for an occult septic venous source,…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Association of lower urinary tract symptoms and OAB severity with quality of life and mental health in China, Taiwan and South Korea: results from a cross-sectional, population-based study
- Ten-Day Quadruple Therapy Comprising Low-Dose Rabeprazole, Bismuth, Amoxicillin, and Tetracycline Is an Effective and Safe First-Line Treatment for Helicobacter pylori Infection in a Population with High Antibiotic Resistance: a Prospective, Multicenter, Randomized, Parallel-Controlled Clinical Trial in China
- The Role of the NLR and PLR in Urinary Tract Infection
- Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic
- Leclercia adecarboxylata urinary tract infection in a patient with bladder cancer and recurrent hematuria
- A Case Series of Staphylococcus lugdunensis Infection in Cancer Patients at an Academic Cancer Institute in the United States
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.