An 86-year-old woman with a 26- year history of diabetes mellitus treated with insulin injection suddenly developed a high fever and severe consciousness disturbance. Blood tests showed a total leukocyte count of 12 770/μL, a C-reactive protein level of 17 mg/dL, and a fasting blood glucose level of 381 mg/dL (21 mmol/L). A computed tomographic scan of the brain showed no focal lesion. Two days later she developed left hemiparesis, and computed tomography revealed the presence of intracranial gas bubbles (Figure 1). She died on the following day. At autopsy, yellow-green suppurative exudates were evident in the subarachnoid space, and occasional small, brownish cystic lesions were visible in sections of the brain. Histologically, acute suppurative meningoencephalitis manifested by severe inflammatory cell infiltration around the meningeal and brain parenchymal blood vessels was confirmed. Moreover, disseminated empty space–containing, often hemorrhagic microabscesses with gram-negative bacilli were observed throughout the entire brain, being more marked in the cortices of the cerebral convex area (Figure 2). Klebsiella pneumoniae was isolated from the cerebrospinal fluid as well as from pieces of cerebral tissue obtained at autopsy. Histologic examination of the general visceral organs revealed severe bronchopneumonia and septicemia.
Tada M, Toyoshima Y, Honda H, Kojima N, Yamamoto T, Nishikura K, Takahashi H. Multiple Gas-Forming Brain Microabscesses Due to Klebsiella pneumoniae. Arch Neurol. 2006;63(4):608-609. doi:10.1001/archneur.63.4.608