Necrotizing Soft Tissue Infection Caused by Klebsiella pneumoniae After Intra-Articular Injection: A Case Report and Literature Review

Background: Necrotizing soft tissue infection is a fulminant, life-threatening condition causing sepsis along with multiorgan failure, with Klebsiella pneumoniae -induced cases rising, especially in diabetics. Intra-articular injection-related Klebsiella pneumoniae -induced necrotizing soft tissue infection has not been reported previously; only 35 Klebsiella pneumoniae -induced extremity necrotizing soft tissue infection cases exist in English literature. Case Presentation: A 67-year-old diabetic woman with hypertension developed right lower extremity Klebsiella pneumoniae -induced necrotizing soft tissue infection post-intra-articular glucocorticoid/anesthetic injection. She had swelling, pain, confusion; computed tomography showed soft tissue swelling/gas, blood culture confirmed Klebsiella pneumoniae , Laboratory Risk Indicator for Necrotizing Fasciitis score was 9 (out of 13). Family refused debridement; despite antibiotics, Continuous Renal Replacement Therapy, and glucose control, she died of multiorgan failure 18 hours post-admission. Conclusion: Klebsiella pneumoniae -induced cases rising, especially in diabetics is highly lethal (38.9% mortality in 36 reviewed cases), with diabetes as the main risk factor. Early diagnosis (computed tomography, Laboratory Risk Indicator for Necrotizing Fasciitis) and aggressive debridement are critical. Intra-articular injection infection prevention and timely etiological exams are essential. Keywords: intra-articular injection, diabetes mellitus, necrotizing soft tissue infection, Klebsiella pneumoniae