title: Fatal Klebsiella pneumoniae meningitis and emphysematous brain abscess after endoscopic variceal ligation in a patient with liver cirrhosis and diabetes mellitus.
abstract: Procedure-related bacterial infections may complicate esophageal variceal ligation in cirrhosis patients. Here, we report a 58-year-old man with underlying diabetes and liver cirrhosis who developed Klebsiella pneumoniae meningitis and brain abscess with gas formation in brain parenchyma and ventricles after this procedure. Despite administration of appropriate antimicrobial therapy, he became comatose on the 3rd day of acute illness and died on the 4th day of hospitalization. This case highlights the indication for antimicrobial prophylaxis in cirrhotic patients with gastrointestinal bleeding, and the need for early and heightened awareness of central nervous system infections in cirrhotic patients with hepatic encephalopathy.
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 704, Taiwan.
authors.forename: Hsin-I
authors.initials: HI
authors.lastname: Shih
authors.forename: Hsin-Chun
authors.initials: HC
authors.lastname: Lee
authors.forename: Chiao-Hsiung
authors.initials: CH
authors.lastname: Chuang
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: D001922:Brain Abscess / Q000000981:diagnostic imaging / Q000209:etiology* / Q000382:microbiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004646:Emphysema / Q000000981:diagnostic imaging / Q000209:etiology*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D007710:Klebsiella Infections / Q000000981:diagnostic imaging / Q000209:etiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008026:Ligation / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D016920:Meningitis, Bacterial / Q000000981:diagnostic imaging / Q000209:etiology* / Q000382:microbiology; D008875:Middle Aged; D013624:Taiwan; D014057:Tomography, X-Ray Computed