To report a rare case of klebsiella meningitis in an immunocompetent host without any recent neurosurgical intervention.

Klebsiella pneumoniae is a rare cause of meningoencephalitis with reported cases accounting for less than 3% of community acquired bacterial meningitis. A majority of cases are described with likely septic metastasis from lesions such as liver abscess causing a disseminated infection. Reported comorbidities in patients with community acquired Klebsiella meningitis were diabetes mellitus and liver cirrhosis.

Case Report

A previously healthy 56-year-old male developed increased fatigue, malaise who was subsequently diagnosed with pneumonia at an ER and discharged home on antibiotics. He delayed starting antibiotics by several days.  On day 3 of his illness, he developed vomiting, diarrhea & severe headache. He was subsequently found unconscious the following day. His initial exam was notable for absence of all brainstem reflexes as well as no motor activity. A bedside point-of-care EEG was performed and demonstrated diffuse slowing without evidence of epileptiform activity. CSF studies significant for glucose less than 2 and protein greater than 600 with approximately 85% nucleated cells (PMNs) and elevated LFTs. MRI brain demonstrated diffuse cerebral edema, tonsillar herniation, and extensive cerebral venous sinus thrombosis. MRA head demonstrated absence of intracranial flow. Although patient was treated aggressively with antibiotics, his exam remained poor. He was subsequently diagnosed with brain death by neurologic criteria. Post-mortem CSF culture grew Klebsiella pneumoniae.

There is high mortality seen in Klebsiella pneumoniae meningoencephalitis. This patient had a positive respiratory culture for K. Pneumoniae with elevated LFTs on presentation. Given patients elevated LFTs there is a possibility that there may have been a hypervirulent variant of K. Pneumoniae that metastatically spread eventually causing severe and rapid meningoencephalitis resulting in rapid brain death and subsequent herniation.