{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:02:46Z","timestamp":1756425766575,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,3,24]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>We present an unusual case of a woman in her 30s who was admitted for diabetic ketoacidosis (DKA) in the setting of newly diagnosed but late COVID-19 infection with associated <jats:italic>Klebsiella pneumoniae<\/jats:italic> infection. Her altered mental status, out of proportion with her metabolic decompensation, revealed a superimposed cerebral venous sinus thrombosis (CVST) with fulminant cerebral oedema and ultimately brain death. This unusual and fulminant case of cerebral oedema in the setting of COVID-19 infection with bacterial infection, DKA and CVST was the perfect storm with multiple interwoven factors. It offered diagnostic and treatment challenges with an unfortunate outcome. This unique case is a reminder that it is important to consider a broad neurological differential in patients with COVID-19 with unexplained neurological manifestations, which may require specific neurointensive care management.<\/jats:p>","DOI":"10.1136\/bcr-2021-248046","type":"journal-article","created":{"date-parts":[[2022,4,4]],"date-time":"2022-04-04T12:06:00Z","timestamp":1649073960000},"page":"e248046","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Diabetic ketoacidosis, cerebral venous sinus thrombosis and fulminant cerebral oedema in COVID-19 infection complicated by <i>Klebsiella pneumoniae<\/i> infection"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7264-9704","authenticated-orcid":false,"given":"Lindsey A","family":"Wallace","sequence":"first","affiliation":[{"name":"Critical Care Independent Multidisciplinary Program, Mayo Clinic, Rochester, Minnesota, 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