A Case of Forearm Soft Tissue Infection Caused by Hypervirulent K. pneumoniae in an Otherwise Healthy 24-Year-Old Woman

Lingwei Kong,1,* Yu Wang,1,* Hairu Ji,2 Zhehong Li,1 Yupeng Sun,1 Yanchao Liu,1 Sheng Cao,1 Jingxin Zhao,1 Litao Shi,1 Yu Jin1 1Department of Orthopedics, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei, 067000, People’s Republic of China; 2Pathology Teaching and Research Section, Chengde Medical College, Chengde, Hebei, 067000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yu Jin Tel +86 13832428328Email 358620793@qq.comAbstract: In recent years, hypervirulent Klebsiella pneumoniae (hvKp) has received greater attention. It mainly infects diabetic patients and typically causes a hepatic abscess. Here, we report a case of hvKp that caused forearm muscle and soft tissue infection in addition to bacteremia, hepatic and pulmonary abscess, and hyperglycemia. The patient’s condition stabilized after comprehensive treatment. She eventually recovered and was discharged after several debridement and flap operations. At 9 months of follow-up, no signs of infectious recurrence were noted, and the hyperglycemia resolved. Here, we detail important clinical features of a severe hvKp case diagnosed in an otherwise healthy individual. This report underscores the potential of hvKp to cause deep tissue infection and present with clinical symptoms similar to gas gangrene. Symptom onset in the setting of hvKp infection is usually gradual and misdiagnosis is common. The diagnosis of hvKp should be routinely considered in the clinical setting, and be strongly suspected when presenting with characteristic epidemiological, clinical and laboratory features. Although diabetes is a predisposing factor to hvKp infection, hyperglycemia appeared to manifest as a consequence of hvKp infection in this patient.Keywords: hypervirulent K. pneumoniae, hvKp, soft tissue infection, liver abscess, lung abscess, diabetes