{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:41:05Z","timestamp":1787755265111,"version":"build-2784847793"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Case:<\/jats:title>\n \n There has been an emerging trend of\n Klebsiella pneumoniae<\/jats:italic>\n necrotizing fasciitis (KP-NF). We report a 50-year-old Chinese woman with rapidly progressive KP-NF, presenting atypically with innocuous skin symptoms. She had newly diagnosed diabetes mellitus. She had extensive subcutaneous crepitus in her lower limbs with subcutaneous gas on x-rays. Despite aggressive surgical debridement, she succumbed to septic shock and multiorgan failure.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n KP-NF is an emerging clinical entity and is associated with a compromised host immunity and high mortality rates. Clinicians must be aware that not all may present with the typical fulminant features and should maintain a high index of suspicion.<\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.cc.23.00130","type":"journal-article","created":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T14:40:12Z","timestamp":1694702412000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Atypical Presentation of Klebsiella pneumoniae Necrotizing Fasciitis of the Lower Extremities: Silent but Deadly"],"prefix":"10.2106","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8411-8716","authenticated-orcid":false,"given":"Bing Howe","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6722-1818","authenticated-orcid":false,"given":"Yen Hsin","family":"Leong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9474-3221","authenticated-orcid":false,"given":"Ernest","family":"Kwek Beng Kee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,7]]},"reference":[{"issue":"3","key":"bib1-20240805","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.cmi.2018.05.008","article-title":"Monomicrobial Klebsiella pneumoniae necrotizing fasciitis: an emerging life-threatening entity","volume":"25","author":"Rahim","year":"2019","journal-title":"Clin Microbiol Infect."},{"issue":"7","key":"bib2-20240805","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1093\/cid\/cis565","article-title":"Recent trend of necrotizing fasciitis in Taiwan: focus on monomicrobial Klebsiella pneumoniae necrotizing fasciitis","volume":"55","author":"Cheng","year":"2012","journal-title":"Clin Infect Dis."},{"issue":"5","key":"bib3-20240805","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s10096-004-1125-5","article-title":"Four cases of necrotizing fasciitis caused by Klebsiella species","volume":"23","author":"Wong","year":"2004","journal-title":"Eur J Clin Microbiol Infect Dis."},{"issue":"23","key":"bib4-20240805","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1056\/NEJMra1600673","article-title":"Necrotizing soft-tissue infections","volume":"377","author":"Stevens","year":"2017","journal-title":"N Engl J 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Dis."},{"issue":"6","key":"bib8-20240805","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1086\/313791","article-title":"Klebsiella pneumoniae necrotizing fasciitis associated with diabetes and liver cirrhosis","volume":"30","author":"Ho","year":"2000","journal-title":"Clin Infect Dis."},{"issue":"1","key":"bib9-20240805","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1186\/s12879-015-1144-0","article-title":"Necrotizing fasciitis in patients with diabetes mellitus: clinical characteristics and risk factors for mortality","volume":"15","author":"Cheng","year":"2015","journal-title":"BMC Infect Dis."},{"issue":"5","key":"bib10-20240805","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/01.ASW.0000269317.76380.3b","article-title":"Necrotizing fasciitis: reviewing the causes and treatment strategies","volume":"20","author":"Salcido","year":"2007","journal-title":"Adv Skin Wound Care."}],"container-title":["JBJS Case 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