Intest Res.  2015 Jan;13(1):85-89. 10.5217/ir.2015.13.1.85.

Perianal Abscess and Proctitis by Klebsiella pneumoniae

• Jeong WS
• Choi SY
• Jeong EH
• Bang KB
• Park SS
• Lee DS
• Park DI
• Jung YS

• KMID: 1807381
• DOI: http://doi.org/10.5217/ir.2015.13.1.85

Abstract

Klebsiella pneumoniae (K. pneumoniae) can at times cause invasive infections, especially in patients with diabetes mellitus and a history of alcohol abuse. A 61-year-old man with diabetes mellitus and a history of alcohol abuse presented with abdominal and anal pain for two weeks. After admission, he underwent sigmoidoscopy, which revealed multiple ulcerations with yellowish exudate in the rectum and sigmoid colon. The patient was treated with ciprofloxacin and metronidazole. After one week, follow up sigmoidoscopy was performed owing to sustained fever and diarrhea. The lesions were aggravated and seemed webbed in appearance because of damage to the rectal mucosa. Abdominal computed tomography and rectal magnetic resonance imaging were performed, and showed a perianal and perirectal abscess. The patient underwent laparoscopic sigmoid colostomy and perirectal abscess incision and drainage. Extended-spectrum beta-lactamase-producing K. pneumoniae was identified in pus culture. The antibiotics were switched to ertapenem. He improved after surgery and was discharged. K. pneumoniae can cause rapid invasive infection in patients with diabetes and a history of alcohol abuse. We report the first rare case of proctitis and perianal abscess caused by invasive K. pneumoniae infection.

Keyword

Klebsiella pneumoniae; Proctitis; Perianal abscess; Diabetes mellitus; Alcoholism

MeSH Terms

Abscess*
Alcoholism
Anti-Bacterial Agents
Ciprofloxacin
Colon, Sigmoid
Colostomy
Diabetes Mellitus
Diarrhea
Drainage
Exudates and Transudates
Fever
Follow-Up Studies
Humans
Klebsiella pneumoniae*
Magnetic Resonance Imaging
Metronidazole
Middle Aged
Mucous Membrane
Pneumonia
Proctitis*
Rectum
Sigmoidoscopy
Suppuration
Ulcer
Anti-Bacterial Agents
Ciprofloxacin
Metronidazole

Figure

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  Fig. 1 Colonoscopic findings on the 7th day of hospitalization. Multiple, various-sized ulcers with yellowish exudate in the rectum and sigmoid colon are seen.

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  Fig. 2 Histologic findings. Intact mucosal architecture and non-specific chronic inflammation are seen (H&E stain, ×100).

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  Fig. 3 Colonoscopic findings on the 14th day of hospitalization. (A) Destroyed colonic mucosa with ulcers in the rectum is seen. (B) Perianal fistula opening and ulceration.

• 

  Fig. 4 CT enterography on the 14th day of hospitalization. (A) An air-containing abscess in the perisacral lesion is seen. (B) A A B perirectal abscess is seen.

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  Fig. 5 MRI on the 15th day of hospitalization. (A) A perirectal fistula is seen (arrow). (B) A perianal fistula A B is seen (arrow).

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