Necrotizing fasciitis of the neck due to hypervirulent Klebsiella pneumoniae: a case report

Abstract

A 68-year-old man was transferred to our hospital presenting with a 3-day history of massive neck swelling and dyspnea; he had medical histories of hypertension, diabetes, and liver cirrhosis. He developed severe respiratory distress with impaired consciousness. He was intubated and admitted to the ICU. For massive neck swelling with purpura and multiple organ failure, he was treated using antibiotics, continuous hemodiafiltration, and drainage of the post-pharyngeal abscess. We found ulcers and blisters, suspicious of necrotizing fasciitis (NF), on his left cervicothoracic skin on hospital day 2. We planned to perform an incision and drainage, but he died within 24 hours of admission. Hypervirulent Klebsiella pneumoniae (hvKP) was detected from blood cultures (positive string test). Genetic testing and whole-genome analysis revealed that this strain belonged to capsule serotype K2 , ST65, and rmpA-positive. To our knowledge, no cases of NF caused by this strain have been reported in Japan. Here, we present a rare case of hvKP infection.