Multi-Organ Abscesses and 5th Cervical Vertebra Bone Destruction Related with Klebsiella ozaenae Infection: A Case Report

Figures & data

Figure 1 Enhanced computerized tomography (CT) of the implicated organs at admission. (A) Superior field of the lung; red arrow indicates multiple pulmonary nodules, partial liquefaction and necrosis; (B) Middle field of the lung; (C) Inferior field of the lung; (D) The right-posterior lobe of the liver; green arrow indicates abscess; (E) Right anterior superior chest wall; green arrow indicates abscess; (F) 5th cervical vertebra bone destruction with prevertebral abscesses; black arrow indicates bone destruction in the 5th cervical vertebra, and green arrow indicates prevertebral abscesses.

Table 1 Antimicrobial Susceptibility Tests and Interpretation Based on Blood, Sputum and Bronchoalveolar Lavage Fluid Isolates

Antimicrobial Agents^a	MICs	Interpretation
Imipenem	≤0.25 μg/mL	Susceptible
Meropenem	≤0.5 μg/mL	Susceptible
Moxifloxacin	1.0 μg/mL	Susceptible
Levofloxacin	≤0.5 μg/mL	Susceptible
Amikacin	≤2.0 μg/mL	Susceptible
Piperacillin/tazobactam	≤16 μg/mL	Susceptible
Cefepime^b	≤1.0 μg/mL	Susceptible
Tigecycline^b	≤0.5 μg/mL	Susceptible
Ceftazidime^c	≤1.0 μg/mL	Susceptible
Ciprofloxacin^c	≤0.25 μg/mL	Susceptible
Cefuroxime	16 μg/mL	Intermediate
Amoxicillin and clavulanate potassium	≥ 32 μg/mL	Resistant
Cefazolin	≥ 64 μg/mL	Resistant
Ticarcillin	≥ 128 μg/mL	Resistant

Notes: ^aAll susceptible antimicrobials and part-resistant antimicrobials are summarized; ^bFor sputum isolate only; ^cFor bronchoalveolar lavage fluid isolate only.

Figure 2 Magnetic resonance imaging (MRI) of the cervical vertebra before operation. Green arrow indicates prevertebral abscess, and red arrow indicates bone destruction in the 5th cervical vertebra.

Figure 3 Postoperative H&E staining of the 5th cervical vertebra showing typical characteristics of chronic inflammation.

Figure 4 CT and MRI figures before second discharge. Focuses were significantly improved after treatment. (A) CT of the superior field of the lung; (B) CT of the middle field of the lung; (C) CT of the inferior field of the lung; (D) CT of the right-posterior lobe of the liver; (E) CT of the right anterior superior chest wall; (F) MRI of the 5th cervical vertebra.