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CASE REPORT
Hypermucoviscous capsular 1 (K1) serotype Klebsiella pneumoniae necrotising fasciitis and metastatic endophthalmitis
  1. Harold Henrison Chang Chiu1,
  2. Christian Nadonga Francisco2,
  3. Racquel Bruno1,
  4. Manuel Jorge II1 and
  5. Edsel Maurice Salvaña2
  1. 1 Department of Medicine, College of Medicine & Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  2. 2 Section of Infectious Diseases, Department of Medicine, College of Medicine & Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  1. Correspondence to Dr Harold Henrison Chang Chiu, harold.c.chiu{at}gmail.com

Abstract

A 48-year-old man presented with a non-healing wound on his left foot after stepping on a nail. He self-medicated with amoxicillin, but the wound progressed prompting consult. On examination, his left foot was diffusely swollen with surrounding erythema, areas of gangrene, foul-smelling purulent discharge and subcutaneous emphysema. He was managed as a case of necrotising fasciitis and underwent emergent amputation. Three days after amputation, he developed a sudden and progressive blurring of vision, swelling and conjunctival erythema, with purulent discharge and the presence of hypopyon on the left eye. He was then managed as a case of endophthalmitis of the left eye and underwent pars plana vitrectomy. All cultures (blood, tissue and vitreous fluid) grew pan-susceptible hypermucoviscous Klebsiella pneumoniae, with positive string tests and confirmed by multilocus gene sequencing and sequence type analysis. He gradually improved with intravenous antibiotics, but only regained light perception in the left eye.

  • infectious diseases
  • tropical medicine (infectious disease)

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Footnotes

  • Contributors HHCC, NNF and RB wrote the bulk of the manuscript. CNF, MCJ, and EMS gave suggestions. HHCC and CNF made the final proof-reading of the text. All authors have contributed significantly and are in agreement with the content of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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