Primary Klebsiella pneumoniae in Lumbar Spine: Case Report and Literature Review

Abstract

Background: Klebsiella pneumoniae infections are predominantly observed in respiratory medicine, but their manifestation in the spine is exceedingly rare. Such infections can be easily manifestation as spinal tuberculosis or other similar infections, resulting in non-standardized treatments and an increased risk of adverse drug reactions. This study aims to explore the standardization and safety of early diagnosis and treatment of Klebsiella pneumoniae infections in the spine. Case presentation: We report the case of a 38-year-old female who presented with an acute onset of lower back pain. Initially diagnosed with spinal tuberculosis at a local community hospital, she was treated with anti-tuberculosis medications, which failed to alleviate her symptoms. Upon re-evaluation with enhanced MRI and additional laboratory tests, a core needle biopsy (CNB) was performed under local anesthesia, confirming Klebsiella pneumoniae as the causative pathogen. Following appropriate antibiotic treatment, the patient's pain symptoms significantly improved. Follow-up lumbar MRI indicated the complete resolution of vertebral and paravertebral abscesses. During a one-year follow-up period, the patient experienced no further complications and successfully conceived, delivering a healthy male infant. Conclusions: This case report highlights the rarity and significance of primary Klebsiella pneumoniae infections in the lumbar spine, emphasizing the need for heightened awareness among clinicians. Despite its infrequency, K. pneumoniae should be considered in differential diagnoses for spinal infections, particularly when tuberculosis is suspected. Early and accurate diagnosis through techniques such as core needle biopsy is crucial for effective management. Our findings suggest that tailored antibiotic therapy, combined with diligent long-term follow-up using MRI, can lead to successful outcomes and minimize the risk of recurrence. Given the challenges posed by potential drug resistance and the complexity of spinal infections, further research is essential to establish standardized treatment protocols and improve patient care in this domain.