Garbati et al. Journal of Medical Case Reports 2012, 6:97 http://www.jmedicalcasereports.com/content/6/1/97 We describe a rare case of LS in a patient with dia- betes caused by K. pneumoniae. We also review the rele- vant literature. Case presentation In November 2010, a 63-year-old Saudi man with back- ground diagnoses of bronchial asthma and type 1 dia- betes mellitus (DM I) of 47 years, presented to our facility with a five-day history of swelling on the right side of his neck and fever. The swelling progressively increased in size and was associated with pain, dyspha- gia, odynophagia, change of voice (’hot potato voice’), and reduced appetite. There was no prior history of shortness of breath, upper respiratory tract infection (URTI), dental problems or procedures. On examination our patient was found to be febrile (38.8°C), diaphoretic with a pulse rate of 115 beats per minute, a respiratory rate of 20 cycles per minute, BP of 119/69 mmHg and oxygen saturation of 99% at room air. There was a right submandibular swelling (5 × 5 cm) with all the cardinal features of acute inflammation (rubor, calor, tumor, dolor, and functio laesa). The first four of these signs were named by Celsus in ancient Rome (30-38 B.C.) and the last by Galen (A.D 130-200) [7].The right tonsil was enlarged and the uvula medially displaced. Page 2 of 4 Examination of the respiratory system did not reveal any abnormalities. Laboratory investigations revealed a white cell count of 10.5 × 109 cells/L (neutrophils 80.8%), hemoglobin 13.9 g/dL, platelet count 479 × 109 cells/L, erythrocyte sedimentation rate (ESR) 44 mm/hour and international normalized ratio (INR) of 3.1. Serum glucose was 23 mmol/L, total cholesterol 2.9 mmol/L, low-density lipo- protein (LDL) cholesterol 1.79 mmol/L, high-density lipoprotein (HDL) cholesterol 0.5 mmol/L and triglycer- ide 1.42 mmol/L. Hemoglobin A1c (HbA1c) was 9.9% on admission. Alanine aminotransferase (ALT) was 21 U/L, aspartate aminotransferase (AST) 6 U/L, uric acid 246 μmol/L, urea 5.5 mmol/L, creatinine 90 μmol/L, and total bilirubin 10.5 μmol/L. Abscess content culture and sensitivity testing yielded K. pneumoniae; however, blood culture results were negative. Serotyping of the K. pneumonia isolate from our patient was not performed. A computed tomography (CT) scan (Figure 1) of the neck region showed a multiloculated abscess (circle of arrowheads) with irregular peripheral enhancement in the right carotid space extending from the second to the fourth cervical vertebrae. The right sternomastoid mus- cle was swollen with surrounding inflammatory changes as well as multiple enlarged cervical lymph nodes. The Figure 1 Computed tomography (CT) scan of the neck region showing the abscess content (circle of arrowheads) and thrombosis in the right internal jugular vein (single arrow).