Meningitis, brain abscess, and endophthalmitis are rare manifestations of <i>K. pneumoniae</i> infection. We present a case of <i>Klebsiella</i> meningitis associated with a brain abscess and endophthalmitis. A 58-year-old man with alcoholic liver cirrhosis and hepatocellular carcinoma presented with fever, pain in the right eyeball, and vision loss. Endophthalmitis and urinary tract infections were identified through ophthalmologic examination and urine analysis, respectively, and empirical antibiotic therapy was administered. Approximately seven days after treatment, the patient presented with persistent headaches. In the cerebrospinal fluid study, the white blood cell count was 210/mm<sup>3</sup>, the protein level was 540 mg/dL, and the glucose level was 28.6 mg/ dL. Magnetic resonance imaging of the brain revealed diffuse brain abscesses in both hemispheres. <i>Klebsiella pneumoniae</i> was isolated from the blood and urine cultures. After intravenous injection of antibiotics (vancomycin and ceftriaxone) for 2 months, the headache resolved and the results of the cerebrospinal fluid study were normal.
More than 50% relevant artery stenosis is regarded as significant and may be responsible for an ischemic lesion in the corresponding brain area. However, a lesion with less than 50% stenosis with carotid plaque is classified as an embolic stroke of an undetermined source and might be underestimated as a potential source of stroke. A 53-year-old woman with motor weakness of the left limb showed multiple scattered small infarct lesions in the right middle cerebral artery territory with less than 50% stenosis of the right carotid artery on magnetic resonance angiography. No embolic source was detected from cardiac assessments. Carotid duplex sonography showed a mobile thrombus and an ulcerative plaque in the right carotid artery, and these were confirmed by digital subtraction angiography. Our case report suggests that carotid duplex sonography can be useful in patients who have ischemic stroke with an embolic pattern without significant arterial stenosis.
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