A Case of Septic Pulmonary Embolism Caused by Pyelonephritis With Klebsiella pneumoniae in a Patient With Poorly Controlled Type 2 Diabetes Mellitus

Abstract

Septic pulmonary embolism (SPE) is caused by the microbe that is responsible for any clinical condition that may include urinary tract infections as in this case. We report a case of pyelonephritis with Klebsiella pneumoniae that led to SPE in an 80-year-old woman with poorly controlled diabetes mellitus (DM). Computed tomography (CT) revealed multiple nodules in the peripheral area of the bilateral lung and a contrast defect in the right renal vein, which was suspected to be an embolism. Blood and urine cultures revealed Klebsiella pneumoniae infection. These results confirmed the diagnosis of pyelonephritis and SPE. Treatment with ceftriaxone, cefazolin, and ciprofloxacin improved the patient's condition.

Keywords: klebsiella pneumoniae (kp); poorly controlled diabetes; septic pulmonary emboli; type 2 diabetes mellitus (dm); urinary tract infection.

Figure 1. Image of chest radiograph on admission

Multiple nodules in the upper bilateral lobe. The arrows indicate pulmonary nodules.

Figure 2. Images of abdominal CT

Bilateral renal swelling and perinephric standing are also observed (a). Poor contrast enhancements in bilateral renal parenchyma are observed (b). Suspected bacterial mass in the right vein. The arrow indicates a suspected bacterial mass (c).

Figure 3. Images of chest CT

Multiple nodules are observed in the peripheral area on admission (a, b). Multiple nodules are enlarged and cavities appeared in some of them on day 4 (c, d). The arrows indicate a nodule with enlargement and a cavity.

Figure 4. Process of treatment and inflammatory markers

The symbol * indicates days of hospitalization. The treatment was initiated with ceftriaxone 2 g per day. After confirming bacterial species and antimicrobial susceptibility, it was de-escalated to cefazolin 6 g per day IV on day 3. Insulin was also initiated to control blood glucose and then switched to oral medication. After treatment initiation, the patient's temperature resolved, and inflammatory markers rapidly decreased. WBC, white blood cell; CRP, C-reactive protein; ABx, antibiotics; BS, blood sugar; CTRX, ceftriaxone; CEZ, cefazolin; IV, intravenous.

Figure 5. One-month follow-up CT after treatment initiation

Bilateral renal swelling improved, and poor contrast enhancement regressed, and the arrow indicates the point at which a suspected bacterial mass was detected on day 4 (a). Multiple nodules and cavities regressed or disappeared. The arrows indicate nodules and cavities with regression and disappearance (b, c).