Abstract
We report a rare case of Klebsiella pneumoniae meningitis associated with liver abscess, which was successfully treated with cefotaxime (CTX), one of the third-generation cephalosporins.
A 53-year-old man was admitted to Keio University Hospital on June 13, 1988, because of a fever and a headache. On June 3, he suddenly started shivering and his temperature rose to 39°C. He then began to complain of polydipsia, polyuria, and a weight loss of 4kg a week. On June 11, he developed a severe headache. Four years prior to this incident, he had been diagonosed as having diabetes after a routine medical examination, but had neglected to undergo medical treatment.
On admission, laboratory data showed leukocytosis, hyperglycemia (394mg/dl) and ketonuria (4+). A lumbar puncture yielded cloudy cerebrospinal fluid (CSF) containing 500/3 cells/mm3, of which about 70% were neutrophils. A diagnosis of diabetic ketoacidosis and purulent meningitis was made. A treatment with ampicillin (ABPC) and CTX,(12g/day, each) was begun. On the third day, cultures of a blood specimen and CSF yielded both K. pneumoniae. The MICs of CTX to K. pneumoniae isolated from blood and CSF were both 0.05μg/ml. ABPC was discontinued, gentamicin was administered for 2 days, CTX was continued at the same dosage level and an administration of prednisolone 40mg daily was begun. While we examined foci of the meningitis, a solitary hepatic abscess was found with an ultrasonography, but it later disappeared completely.
In our case, CTX was effective in the treatment of both meningitis and liver abscess. It is postulated that the meningitis was a complication of the bacteremia initiated by the liver abscess.
