153 Malaysian J Pathol 2012; 34(2) : 153 – 156 Klebsiella ozaenae sepsis in a young healthy male Yared Wondmikun ENDAILALU MD, PhD, Peter SEALY MD, Miriam MICHAEL MD, Kauter AL KHALLOUFI MD and Hasan NABHANI MD* Departments of Internal Medicine and *Radiology, Howard University Hospital, Washington, DC, USA Abstract Introduction: K. ozaenae is a weak pathogenic organism known to cause primary atrophic rhinitis or ozena. There are few reports that the bacteria could cause serious invasive infection in debilitated patients. This is first report of K. ozaenae in a young previously healthy adult. Case presentation: A 34-year-old Filipino male with no significant previous medical history presented with severe frontal headache of two days duration with fever and chills. Blood and serum work-up showed leukocytosis, mild thrombocytopenia, hypomagnesemia, hypokalemia, and hypophopatemia. Liver function test indicated elevated bilirubin and transaminases. CT of the head indicated sinus disease including mucoperiosteal-like thickening of the right maxillary sinus, left mastoid hypoaeration and sclerosis characteristics of chronic inflammation. Blood culture grew gram negative rods identified as Klebsiella ozaenae species. Conclusion: Klebisella ozaenae sepsis is rarely reported in medical literature. There are about 12 case reports all of which identified with one or more chronic conditions causing decline in patient immunity resulting in invasive infection by the weak pathogen. Our patient is a young physically active adult male with no identifiable risk factors except chronic ozena-like infection that might serve as a source for haematologic seeding. Keywords: Klebsiella ozaenae, sepsis, ozena Address for correspondence and reprint requests: Yared W. Endailalu, Howard University Hospital, Department of Internal Medicine, 2041 Georgia Avenue NW, Washington, DC 20060, USA. Tel: 001 202 865 1920; Fax: 001 202 865 7199. Email: yared.endailalu@howard.edu CASE REPORT INTRODUCTION Klebsiella ozaenae is a gram negative aerobic bacillus, a member of a family Enterobacteriaceae. Members of Klebsiella genus typically express lipopolysaccaride (O) and capsular polysaccharide (K) antigens which are the base of their serotype variability and virulence. K. ozaenae is a weakly pathogenic organism known to be a causative agent of the rare disease primary atrophic rhinitis or ozena. 1 Patients with ozena have progressive chronic inflammatory disease of the upper respiratory tract with a distinctive feature of fetid endonasal crusting and discharge with mucosal atrophy and bone resorption. 2 Patients may present with chronic nasal discharge and malodor, anosmia, epistaxis, nasal obstruction or headache. Mucoperiosteal wall thickening of the maxillary and ethmoid sinus is a characteristic radiological finding in chronic infection with Klebsiella ozaenae. 3 There are only few literature reports that this bacterium is associated with serious invasive infection such as meningitis, 4 sepsis 5 and intracranial abscesses. 6 Here we report a case of K. ozaenae sepsis in a patient with asymptomatic sinusoidal and mucosal changes. CASE REPORT A 34-year-old Filipino male who is working in a Sushi Bar with no significant previous medical history presented with severe frontal headache of two days duration with fever, chills, loss of appetite, nausea and one episode of vomiting. The patient reports no abdominal pain, diarrhoea, cough, skin rash, recent throat infection, neck stiffness, blurring of vision, nasal discharge, tinnitus or urinary symptoms. The patient denied contact with similarly ill patients, recent travel or head trauma. He stated that he drinks once to twice weekly about 4-6 beers in a session. At admission his axillary temperature was 101.5 0 F, blood pressure 110/60 mmHg, respiratory rate 18/min, pulse 108 beats/min and SaO 2 99% in ambient air. He is a well-built athletic young male with slightly dry buccal and glossal surfaces. The remaining physical examination