title: Klebsiella pneumoniae necrotizing fasciitis of the leg in an elderly French woman.
abstract: Klebsiella pneumoniae necrotizing fasciitis is a rare infection in regions outside of Asia. Here, we present a case of necrotizing fasciitis of the leg caused by K. pneumoniae in a 92-year-old French woman hospitalized in a geriatric rehabilitation unit. The patient initially presented with dermohypodermitis of the leg that developed from a dirty wound following a fall. A few hours later, this painful injury extended to the entire lower limb, with purplish discoloration of the skin, bullae, and necrosis. Septic shock rapidly appeared and the patient died 9 hours after the onset of symptoms. The patient was Caucasian, with no history of travel to Asia or any underlying disease. Computed tomography revealed no infectious metastatic loci. Blood cultures showed growth of capsular serotype K2 K. pneumoniae strains with virulence factors RmpA, yersiniabactin and aerobactin. This rare and fatal case of necrotizing fasciitis caused by a virulent strain of K. pneumoniae occurred in a hospitalized elderly woman without risk factors. Clinicians and geriatricians in particular should be aware of this important albeit unusual differential diagnosis.
authors: Assistance Publique-Hôpitaux de Paris (AP-HP), GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d'Heur et Chemin Delatour, Ivry s/Seine, Paris, France.
authors: Marguerite
authors: M
authors: Monié
authors: Assistance Publique-Hôpitaux de Paris, Hôpital Charles-Foix, Bactériologie-Hygiène, Paris, France ; Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France ; INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France.
authors: Laurence
authors: L
authors: Drieux
authors: Assistance Publique-Hôpitaux de Paris (AP-HP), GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d'Heur et Chemin Delatour, Ivry s/Seine, Paris, France.
authors: Bernadette
authors: B
authors: Nzili
authors: AP-HP, GHU Henri Mondor, Département de Médecine Interne et Gériatrie, Créteil, France.
authors: Michèle
authors: M
authors: Dicko
authors: Assistance Publique-Hôpitaux de Paris (AP-HP), GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d'Heur et Chemin Delatour, Ivry s/Seine, Paris, France.
authors: Catherine
authors: C
authors: Goursot
authors: AP-HP, GHU Pitié Salpêtrière-Charles Foix, site Pitié Salpêtrière, Service de Médecine Gériatrique, Paris, France.
authors: Sandrine
authors: S
authors: Greffard
authors: Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France ; INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France ; AP-HP, Hôpital Saint-Antoine, Bactériologie-Hygiène, Paris, France.
authors: Dominique
authors: D
authors: Decré
authors: Assistance Publique-Hôpitaux de Paris (AP-HP), GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d'Heur et Chemin Delatour, Ivry s/Seine, Paris, France.
authors: Anthony
authors: A
authors: Mézière
mesh_terms: D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000382:microbiology*; D017809:Fatal Outcome; D005260:Female; D005602:France; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications* / Q000175:diagnosis*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D007866:Leg
keywords: Klebsiella pneumoniae; elderly; necrotizing fasciitis