Three episodes of meningitis due to Klebsiella pneumoniae occurred in a young man following cerebral surgery. The patient had the features of Nelson's syndrome, and a chromophobe adenoma was removed by trans-sphenoidal resection. Intravenous chloramphenicol was effective in producing a temporary clinical response during the first episode of meningitis, but the organism became resistant to chloramphenicol during the second episode. Combined parenteral and intralumbar administration of gentamicin resulted in temporary improvement only. Subsequently, the subcutaneous cerebrospinal fluid (CSF) reservoir of Ommaya provided a safe, convenient way to administer prolonged intraventricular therapy which, combined with a definitive procedure to correct the cerbrospinal fluid rhinorrhea, ultimately cured the infection.
Madhavan, Tom; Kiani, Daria; Saravolatz, Louis; Burch, Keith; and Mellinger, Raymond C.
"Recurrent Klebsiella Meningitis Following Trans-sphenoidal Hypophysectomy for Nelson's Syndrome: Chloramphenicol resistance during relapse,"
Henry Ford Hospital Medical Journal
: Vol. 28
Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol28/iss2/11