Gas-forming brain abscess caused by Klebsiella pneumoniae

Abstract

Gas forming brain abscess is a rare disease caused by Klebsiella pneumoniae occurring in patients with impaired host defense mechanism such as diabetes mellitus or liver cirrhosis. A 59-year-old man with 2-year history of diabetes mellitus and 20-year history of liver cirrhosis presented to the hospital with headache. On the day after admission, severe headache was developed and he deteriorated rapidly. Brain CT showed a non-enhanced mass including multiple air density as well as surrounding edema seen in the right occipital lobe, and isodensity air-fluid level seen in the right lateral ventricle. Despite emergent ventricular drainage and intraventricular and intravenous administration of antibiotics, his condition progressively worsened to sepsis and to death after 5 days. Bacterial culture of blood and ventricular fluids disclosed a Gram (-) rod, Klebsiella pneumoniae. In this report we review the pathogenic mechanism and its management.

Keywords: Air; Brain abscess; Klebsiella pneumoniae.

Fig. 1

Brain computed tomography shows non-enhanced low density mass with multiple air density and surrounding edema seen in the right occipital lobe, and isodense air-fluid level in the right lateral ventricle.

Fig. 2

Gram stain showing numerous G (-) bacilli proven to be Klebsiella pneumonia through cultivation on Mackonkey Agar.