ABSTRACT

For 20 years she had been suffering from sudden falls without loss of conciousness 3-4 times a month after which she could not move her body for approximately 30 seconds following a a complete recovery in 10 minutes. Sometimes these episodes were triggered by emotions. She experienced excessive daytime sleepiness, but had trouble sleeping at night and was subjected to sleep paralysis with hypnagogic and hypnopompic hallucinations especially when waking up in the morning or during the night.A hypothesis of narcolepsy with cataplexy (NT1) was presented.The following investigations were performed: electroencephalogram and magnetic resonance imaging of the brain revealed no abnormalities. Lumbar puncture showed no signs of infection. Levels of CSF hypocretin on the other hand were decreased (82 pg/ml). NT1 is characterized by a low hypocretin level (b110 pg/ml). She tested positive for both narcolepsy related HLA allels DQB1*06:02 and DQA1*01:02. She was diagnosed with narcolepsy type 1. She was prescribed 200 mg modafinil and 150 mg venlafaxine daily. That has been reducing her daytime sleepiness, cataplexy and sleep paralysis.

Abstract:Klebsiella, a gram negative bacteria, can cause a variety of clinical syndromes in human beings. These include pneumonia, urinary tract infection, abdominal infection, surgical site infection, soft tissue infection and infections of intravascular devices. Middle-aged and elderly individuals with chronic debilitating diseases like diabetes, alcoholism, and immunocompromised persons are more susceptible to Klebsiella infections. This case report is regarding a diabetic patient, on treatment for rheumatoid arthritis, who developed cellulitis of leg with multiple thigh abscesses due to Klebsiella, which happens to be a rare presentation.