Objective: Klebsiella pneumoniae causes different type of community-acquire and nosocomial infections including pneumonia, sepsis and liver abscess. Klebsiella pneumoniae is considered as the uncommon pathogen for bacterial meningitis. In Klebsiella pneumoniae meningitis, neurological manifestations can occur including changes in mental status or seizures as common symptoms, however, chorea had not been reported as neurological symptoms.

Background: Here, we report a male patient who presented with chorea as his initial neurologic symptom of Klebsiella pneumoniae meningitis, who recovered after antibiotics treatment with no residual chorea.

Method: A 66-year-old man was admitted to the internal medicine department due to a high fever. The clinical manifestations, laboratory and imaging findings were compatible with sepsis due to primary liver abscess (66.65mm 23.33mm). A pigtail catheter drainage and antibiotic treatment was started.

Results: On hospital day 3, the patient was referred to neurology department due to involuntary movement which involved face, neck, trunk and both hand and confused mentality. Lumbar puncture was done. Cerebrospinal fluid (CSF) analysis showed; WBC of 1,600/μL with 72% of neutrophils, 13% of lymphocytes; glucose of 80mg/dL (serum glucose of 205mg/dL) and protein of 201mg/dL. Brain MRI revealed diffuse high signal intensity in subarachnoid space on T2 fluid-attenuated inversion recovery (FLAIR) images with mild leptomeningeal enhancement and intraventricular abscess in dependent portion of lateral ventricle. Our tentative diagnosis was bacterial meningitis and ventriculitis related to the liver abscess.
We escalated intravenous ceftriaxone dose to 2g every 12 hour and added ampicillin 2.6g every 4 hours to regimen.
As we used proper antibiotics before lumbar puncture, there was no growth of organisms in viral polymerase chain reaction (PCR) and CSF culture
On hospital day 8, chorea disappeared, and on hospital day 11, patient’s mental status fully recovered. On hospital day 34, patient discharged to home without any complications.

Conclusion: This case has importance of unusual chorea occurrence in meningitis. Early suspect and proper use of antibiotic are important for prognosis. Although choreic movement is uncommon manifestations in CNS infection, early neurological diagnosis and proper antibiotic use may be helpful.

References: 1. Wen-Liang Yu, MD, Yin-Ching Chuang, MD Clinical features, diagnosis, and treatment of Klebsiella pneumoniae infection. Uptodate 2019 2. Bartt R. Acute bacterial and viral meningitis. Continuum (Minneap Minn) 2012;18:1255–70

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MDS Abstracts - https://www.mdsabstracts.org/abstract/klebsiella-pneumoniae-meningitis-presenting-with-chorea/