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Case report
3-in-1: bilateral subcutaneous leg abscesses and liver abscess from Klebsiella pneumoniae
  1. Mark Anthony Santiago Sandoval1,2,
  2. Ma Carrissa Abigail Roxas1,
  3. Maria Sonia Salamat3,
  4. Jarold Pauig4,
  5. Irewin Tabu5 and
  6. Angelo dela Tonga6
  1. 1Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  2. 2Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
  3. 3Division of Infectious Disease, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  4. 4Department of Radiology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  5. 5Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  6. 6Institute of Molecular Biology and Biotechnology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
  1. Correspondence to Dr Mark Anthony Santiago Sandoval; mssandoval1{at}up.edu.ph

Abstract

Hypervirulent strains of Klebsiella pneumoniae are known to cause liver abscesses and other metastatic infections. Being Asian and having diabetes are known host risk factors. Here we present an unusual case of a Filipino ballet dancer–choreographer with diabetes presenting with bilateral leg pains initially thought to be cellulitis, but was eventually diagnosed as bilateral subcutaneous leg abscesses. He also had a liver abscess, thankfully asymptomatic, which was only discovered on imaging. The occurrence of three distant abscesses in one patient, hence ‘3-in-1,’ makes this case worth reporting. Bilateral subcutaneous leg abscesses as the presenting manifestation of this infection have not been reported yet. We hypothesise that his occupation which makes use of frequent contractions of leg muscles led to increased blood flow and preferentially directed blood-borne bacteria to localise in both legs. We have also characterised the pathogen with regards to its hypermucoviscous phenotype, capsular type, virulence genes and phylogeny.

  • diabetes
  • infectious diseases
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Footnotes

  • Contributors MASS is the attending physician and wrote the majority of the initial draft. MCAR, MSS, JP and IT were involved in the diagnosis and treatment of the patient and contributed to the writing of the manuscript. AD performed the bacteriological analysis. All approved the final version 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 for publication Obtained.

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

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