Klebsiella pyomyositis with complications: a quadriceps quandary in a dialysis patient

The authors report an extremely rare case of Klebsiella pneumoniae pyomyositis of the left thigh in a patient with type II diabetes mellitus on renal replacement therapy (haemodialysis), with untreated hepatitis C. This patient presented via the dialysis unit with fevers, rigors and a swollen left thigh and knee. Initial differential diagnoses included deep vein thrombosis with systemic inflammatory response syndrome, septic arthritis and crystal arthropathy—all of which were subsequently excluded. Although missed on ultrasound duplex scan, lower limb magnetic resonance imaging (MRI) revealed communicating abscesses in the anterior and medial compartments of the left thigh, with associated inflammation of the muscle. Blood cultures on admission and cultures from direct aspiration of the abscesses grew Klebsiella pneumoniae. The abscesses were managed with a computed tomography-guided drain and combination antibiotic therapy.