POS-133 CASE REPORT OF DISSEMINATED KLEBSIELLA INFECTION IN T2DM LEADING TO CKD

Abstract

K. pneumoniae can present as two forms of community-acquired pneumonia, acute and chronic. Although acute pneumonia may turn into necrotizing pneumonia, which results in a prolonged clinical course, it often has a rapidly progressive clinical course. In contrast, chronic Klebsiella pneumonia runs a protracted indolent course that mimics other chronic pulmonary infections and malignancies. The Klebsiella pneumoniae bacteria usually affects the right upper lung lobe and results in the creation of a cavity, as well as pus-producing tissue death.K. pneumoniae is an aggressive microorganism, accounting for 0.5 to 5% of pneumonia cases. It can lead to cavitation (30-50% of cases) and necrotising pneumonia (NP) within a short period of time (days). Case : 40 year old male with a history of diabetes mellitus (DM) was admitted 20 days back patient was admitted and treated for DKA and LRTI discharged after treatment. Patient readmitted 20 days later with complaints of right sided loin pain, high grade fever of 8 days, cough with expectoration for one month, pyuria for 5 days and anuria for one day. Patient readmitted On admission – P-96/min, BP-140/90 mmhg, RR-26/min, Spo2-96% with O2. On evaluation patient was found to have raised creat (8mg/dl) initiated on hemodialysis. Patient ultrasound showed of left sided bulky kidney with acute pyelonephritis. CXR showed cavitatory lesion in middle lobe of right side lung. 5days Later patient complaint of increased left loin pain repeat USG showed left sided psoas abscess so CT showed no any evidence of communication of pyelonephritis with abscess. Pigtail drain was placed for psoas abscess, culture which was positive for klebsiella. Sputum culture was positive for klebsiella, A diagnosis of dissiminated klebsiella infection was made. In spite of all necessary investigations and treatment patient was dialysis dependent, patient deteriorated over time and could not be saved. Investigations :Tabled 1ParametersValuesHemoglobin9.8 gm/dlTotal leukocyte counts25,500/cummPlatelets2.4 lac/cummUrea104 mg/dlCreatenine4.2 mg/dlSerum Na136 mmol/lSerum K4.5 mmol/lBilirubin1.5 mg/dlSGOT/SGPT45/32Calcium7.6 mg/dlPhosphorus5.8 mg/dlUric acid6.2 mg/dlHbA1c10.5%Urine examinationAlb ++ Sug + Epi cells 1-2/min Pus cells - plenty RBC - 1-2/hpf24 hr urinary protein1.5 gm/day Open table in a new tab Sputum culture & Pus culture – klebsiella Sputum for MTB - negative Fundus – moderate NPDR CXR – Cavitatory lesion in right lung middle zone USG – RK – 12.5*5.9cm, LK – 13.6*6.2cm mod dilation of pelvicalyceal system bilateral bulky kidneys with left acute pyelonephritis. CT abd – left psoas bulky with evidence of 8*2.5 cm well defined hypodense collection within. CT chest – Thick walled cavitatory lesions with surrounding consolidation noted in medial segment of right middle lobe, postero-basal segment of right lower lobe, superior segment of left lower lobe We conclude that patients with immunocompromised state like Diabetes mellitus are more prone to disseminated infections which can lead to high morbidity and mortality. Good glycemic control, early diagnosis and effective management with could be key role in managing a diabetic patient.