Leukocytoclastic vasculitis complicating Klebsiella pneumoniae bacteremia

A 79-year old woman, with a history of hypertension, presented with clinica l features of congestive heart failure, fever, a purpuric rash, and left lo wer quadrant abdominal tenderness. Contrast computed tomography scan of the abdomen showed features of acute diverticulitis, and blood culture was sub sequently positive for Klebsiella pneumoniae. Histological examination of a biopsy of the rash confirmed a diagnosis of leukocytoclastic vasculitis (L CV). The bacteremia responded to intravenous amoxycillin/clavulanic acid an d gentamicin and the rash subsided. This case represents the first case of LCV complicating K. pneumoniae bacteremia in the English literature. The En glish literature on bacteria-associated LCV is reviewed. Taking aside organ isms such as Rickettsia that cause endothelial invasion, the associated bac terial species tends to be subacute or chronic pathogens e.g. Mycoplasma pn eumoniae, Mycobacterium tuberculosis, and Yersinia enterocolitica; or the d isease process is of a subacute or chronic nature e.g. endocarditis, bronch iectesis, and cystic fibrosis, leading to prolonged exposure to pathogens t hat apparently cause acute pyogenic infections, such as K. pneumoniae. (C) 2000 Elsevier Science Inc. All rights reserved.