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Necrotizing fasciitis caused by Klebsiella pneumoniae has been described in Southeast Asia, but has only recently begun to emerge in North America. The hypermucoviscous strain of K. pneumoniae is a particularly virulent strain known to cause devastatingly invasive infections, including necrotizing fasciitis. Here we present the first known case of necrotizing fasciitis caused by hypermucoviscous K. pneumoniae in North America. [West J Emerg Med. 2015;16(1):165–168.]

Necrotizing fasciitis caused by Klebsiella pneumoniae has been described in Southeast Asia, but has only recently begun to emerge in North America. The hypermucoviscous strain of K. pneumoniae is a particularly virulent strain known to cause devastatingly invasive infections, including necrotizing fasciitis. Here we present the first known case of necrotizing fasciitis caused by hypermucoviscous K. pneumoniae in North America. [West J Emerg Med. 2015;16(1):–0.]

A 70-year-old man presented to an emergency department (ED) in California in mid- January with a 2-day history of subjective fever, nonproductive cough, and chest pressure. The chest pressure was constant and was aggravated by deep inspiration and by his being in a supine position. He reported decreased exercise tolerance. He had normally been able to walk five blocks, but he now became dyspneic when he walked a few feet. He also reported a 7-day history of watery diarrhea that had resolved 1 day before presentation. The patient's medical history included type 2 diabetes, hypertensive cardiomyopathy, heart failure (most recent ejection fraction, 50 to 55%), hyperlipidemia, and gout. He had been hospitalized 5 years before this presentation for an episode of systolic heart failure, with an ejection fraction of 20%. The patient had emigrated from Thailand 10 years previously and spoke a language in the Mien family. He declined an interpreter and provided a medical history through his English-speaking daughter. He did not drink alcohol or smoke tobacco. His medications included amlodipine, carvedilol, simvastatin, aspirin, furosemide, metformin, and glipizide. On arrival at the ED, his blood pressure was 133/88 mm Hg, heart rate 109 beats per minute, respiratory rate 18 breaths per minute, temperature 38.5°C (101.3°F), and oxygen saturation 98% while he was breathing ambient air. He appeared diaphoretic and dyspneic, and he used accessory muscles during inspiration. There was no jugular venous distention, and he had no cardiac murmur or rub. Bibasilar crackles were heard. There was mild edema of both lower legs and feet. The physical examination was otherwise normal. [ABSTRACT FROM AUTHOR]

To the Editor: A distinctive form of tissue-invasive community-associated Klebsiella pneumoniae infection, typified by primary liver abscess and bacteremia, has been well known in Asia for 2 decades (1-4). Association [...]