title: A rare presentation of systemic emphysematous infections secondary to Klebsiella pneumoniae bacteremia in a diabetic patient.
abstract: BACKGROUND
  Diabetic patients are at an increased risk of developing Klebsiella pneumoniae pyogenic liver abscess (KLA) and its extrahepatic complications. This is the first case report depicting the concurrence of pyogenic liver abscess, emphysematous pyelonephritis, and necrotizing fasciitis in 1 patient.
  
  
  METHODS
  A 29-year-old male with a history of poorly controlled diabetes presented to the emergency department with lower back pain and right lower leg pain for 1 week. Abdominal ultrasound and computed tomography revealed pyogenic liver abscess, bilateral emphysematous pyelonephritis, and right lower-extremity necrotizing fasciitis. The patient then received emergent fasciectomy and bilateral percutaneous nephrostomy. K. pneumoniae was isolated from the blood culture, right nephrostomy tube, and right lower-extremity wound, indicating that it was the cause of these infections. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In diabetic patients diagnosed with KLA, an emergency physician must perform thorough examinations to exclude potential systemic extrahepatic infections. KLA seeding infections are usually hematogenous in origin, as bacteremia is significantly more common in KLA than other pyogenic liver abscess. Documented sites of KLA seeding include eyes, lungs, kidneys, brain, meninges, soft tissues, and bone.
authors: Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors: Daniel
authors: D
authors: Lai
authors: Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors: Kuang-Chau
authors: KC
authors: Tsai
authors: Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors: Mau-Sheng
authors: MS
authors: Lin
authors: Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors: Tzu-Kai
authors: TK
authors: Lin
authors: Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors: Chieh-Min
authors: CM
authors: Fan
authors: Department of Urology, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors: Hsiao-Chun
authors: HC
authors: Chang
authors: Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors: Jen-Tang
authors: JT
authors: Sun
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000150:complications* / Q000382:microbiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004646:Emphysema / Q000175:diagnosis / Q000382:microbiology*; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000382:microbiology*; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications*; D007711:Klebsiella pneumoniae; D046290:Liver Abscess, Pyogenic / Q000175:diagnosis / Q000382:microbiology*; D008297:Male; D011704:Pyelonephritis / Q000175:diagnosis / Q000382:microbiology*
keywords: Klebsiella pneumoniae; bloodstream infection; diabetes mellitus; emphysematous pyelonephritis; necrotizing fasciitis; pyogenic liver abscess