PMC5348466_01
String test. The test result was considered positive, since a string with a length exceeding 5 mm was obtained. In this case, the string reached a length of 8 mm, confirming the hyperviscosity of the pathogen.
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On Day 2, K. pneumoniae was identified, and positive results were obtained on the "string test"; a viscous string with a length exceeding 5 mm indicates a positive result when bacterial colonies are stretched on an agar plate (Fig. 1).
Axial diffusion magnetic resonance imaging results on Day 7. Note the multiple high-intensity areas of the leptomeninges, which are suggestive of severe inflammation (arrows).
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Day 7, the patient remained in a deep coma, and we therefore performed contrast-enhanced MRI. Diffusion-weighted images (DWIs) showed multiple high-intensity areas of the leptomeninges (Fig. 2), but contrast-enhanced MRI did not detect any brain abscesses.
(a) Axial contrast-enhanced magnetic resonance imaging (MRI) results on Day 23. Contrast-enhanced MRI shows a 5-mm nodal enhancement in the left pia region of the insula. (b) Axial diffusion-weighted images (DWIs) results on Day 23. DWIs did not show any abnormality in the same area. (c) Contrast-enhanced MRI results on Day 40 confirm the disappearance of the contrast- enhanced lesion.
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MRI showed a 5-mm nodal enhancement in the left pia region of the insula (Fig. 3a), but DWIs did not indicate a high-intensity signal in the same area (Fig. 3b), suggesting subacute inflammation. MRA did not show any evidence of an infectious aneurysm. On Day 40, the high-intensity area was not observed on MRI (Fig. 3c), and antibacterial therapy was discontinued.