Ghorashi et al. Journal of Medical Case Reports 2011, 5:241 http://www.jmedicalcasereports.com/content/5/1/241 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Arthritis, osteomyelitis, septicemia and meningitis caused by Klebsiella in a low-birth-weight newborn: a case report Ziaaedin Ghorashi1, Nariman Nezami2*, Hamideh Hoseinpour-feizi1, Sona Ghorashi3 and Jafar Sadegh Tabrizi4 Abstract Introduction: Klebsiella pneumoniae is in most cases a hospital-acquired infection and presents as pneumonia, septicemia and meningitis in patients with some predisposing factors, including prematurity, intravenous catheter, history of antibiotic therapy and intravenous nutrients. Case presentation: A low-birth-weight, 33-day-old Caucasian girl with respiratory distress syndrome was admitted to our hospital. She developed septicemia, meningitis, polyarticular arthritis and osteomyelitis by nosocomial K. pneumoniae which was resistant to most antibiotics except ciprofloxacin. She was therefore treated with ciprofloxacin and co-trimoxazole for eight weeks. After completion of the treatment course, she completely improved with excellent weight gain and without any adverse effects during three years of follow-up. Conclusion: In the resistant strain of K. pneumoniae, ciprofloxacin could be considered as a therapeutic option with the prospect of a good outcome, even in neonates and infants. Introduction Pneumonia is a type of infection that is most commonly caused outside the hospital by Klebsiella pneumoniae [1]. Mostly, K. pneumoniae is recognized as a hospital- acquired infection presenting as pneumonia, septicemia and meningitis in patients with some predisposing fac- tors (including prematurity, intravenous catheter, history of antibiotic therapy and intravenous nutrients) [2,3]. In the rare patients with underlying conditions among newborns and older adults, K. pneumoniae may result in arthritis and osteomyelitis. All Klebsiella subtypes are resistant to ampicillin, especially multi-drug-resistant (MDR) subtypes which are resistant to the majority of antibiotics, except fourth-generation cephalosporins and carbapenems. Previously, patients with MDR subtype infections usually received first-generation cephalsporins and aminoglycosides. * Correspondence: Dr.nezami@gmail.com 2Drug Applied Research Center, Tabriz University (Medical Sciences), Tabriz, Iran Full list of author information is available at the end of the article Case presentation A 33-day-old Caucasian girl was brought to the Tabriz Children’s Hospital with poor breastfeeding, recurrent vomiting and anorexia. She was admitted with a primary diagnosis of septicemia. She was born from a mother with pre-eclampsia through normal vaginal delivery at the 34th week of gestation, with a birth weight of 1670 g. Her Apgar scores at one and five minutes were five and six, respectively. During delivery and before admission to the Tabriz Chil- dren’s Hospital, she had been hospitalized in the Talegani neonatal intensive care unit for prematurity, septicemia, respiratory distress syndrome and gastrointestinal bleed- ing. In Talegani Hospital, she had received antibiotic therapy, including ampicillin and gentamicin, then her medication was changed to cefotaxime and vancomycin, and finally her treatment continued with intravenous immunoglobulin, imipenem and ceftazidime. Her physical examination revealed that she was pale, cachectic, anorexic and hypotonic, and her Moro and sucking reflexes were weak. She also exhibited grunting and had substernal and intercostal retraction. The patient’s body weight, height and head circumference were 1700 g, 43 cm and 31 cm, respectively. Her vital © 2011 Ghorashi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.