# Neuro-Ophthalmological and Musculoskeletal Complications Due to Disseminated Klebsiella pneumoniae Infection: A Case Report and Proposed Management Framework

## TL;DR

A 48-year-old woman with a K. pneumoniae infection developed rare neurological and musculoskeletal complications, highlighting the need for a new management framework.

## Contribution

The paper proposes a new diagnostic and management framework for brain abscess caused by K. pneumoniae.

## Key findings

- Disseminated K. pneumoniae infection can lead to midbrain abscess, liver abscess, and osteomyelitis.
- Neurological complications such as third and fourth nerve palsy, hemiplegia, and Parinaud syndrome can occur.
- The case highlights the importance of early diagnosis and management of invasive K. pneumoniae infections.

## Abstract

Klebsiella pneumoniae is known to cause pneumonia, urinary tract infections, bacteremia, meningitis, and liver abscesses in immunocompromised individuals. A distinct invasive syndrome has been reported in Southeast Asia in the past two decades, whereby K. pneumoniae results in liver abscesses and extrahepatic complications in immunocompetent individuals. We present a case of disseminated K. pneumoniae infection, with metastatic infections of midbrain abscess, liver abscess, and osteomyelitis. A 48-year-old female with a history of chronic alcohol intake, hypertension, and gout presented to our emergency department with diplopia and right ptosis. A right third nerve palsy was noted on admission, and she subsequently developed right fourth nerve palsy, left hemiplegia (Weber's syndrome), and left partial Parinaud syndrome over the course of her hospitalization. This case illustrates both common and uncommon complications of invasive K. pneumoniae infection. We also propose a framework for the diagnosis and management of brain abscess.