Infective endocarditis secondary to Klebsiella pneumoniae-associated emphysematous cystitis

Klebsiella pneumoniae is responsible for about 1.5% of infective endocarditis (IE) cases. IE caused by community-acquired K. pneumoniae infection has rarely been reported. An 80-year-old man presented at our hospital with hypotension and hypoxaemia, and a history of aortic valve stenosis and no history of recent dental treatment. Transthoracic echocardiography at admission showed no signs of heart failure or vegetation. CT revealed typical signs of emphysematous cystitis (EC). The patient was treated for EC-associated septic shock. K. pneumoniae was detected in urine and blood cultures on day 3. Symptoms of heart failure developed on day 6 and clinical examination revealed a heart murmur. An identification of vegetation and perforation of the mitral valve on repeat echocardiography confirmed the diagnosis of IE secondary to K. pneumoniae infection. A surgical valve replacement was performed on day 7. Repeated point-of-care ultrasound played a role in the early diagnosis of IE.