A 4-month-old male infant was transferred to our hospital for evaluation of a progressive cranial defect with purulent drainage. According to extremely limited available medical records, the child had been diagnosed with neonatal bacterial meningitis on day 2 of life. Klebsiella pneumoniae was isolated from cerebrospinal fluid (CSF), and intravenous antibiotics were initiated. Hydrocephalus developed by the third week of life, necessitating placement of an external ventricular drain (EVD). Despite prolonged antibiotic treatment and serial CSF sampling, the infection persisted.

On admission, the infant exhibited a large cranial defect with destruction of the scalp, bone, dura, and cerebral parenchyma. The right parietal bone was exposed and protruded through necrotic soft tissue, with ongoing purulent discharge. Neurological examination was grossly unremarkable. Emergency debridement and skin grafting were performed. The child was discharged in stable condition to local care but was lost to follow-up.

Discussion: This case highlights a rare and visually striking consequence of neonatal Klebsiella pneumoniae meningitis, illustrating the potential for cranial and cerebral destruction despite likely appropriate early intervention. EVD placement, though necessary, may serve as a conduit for persistent Gram-negative CNS infection in neonates. Early detection of treatment failure, rigorous infection control, and prompt neurosurgical assessment are essential in such high-risk neonatal infections. Basu et al. (2001) provided one of the earliest documented cases of neonatal Klebsiella brain abscess. A 2025 case series further emphasized the importance of early surgical evacuation and prolonged antimicrobial therapy, showing improved outcomes.

Conclusion: Neonatal Klebsiella pneumoniae meningitis can result in catastrophic neurologic sequelae even with timely treatment. This case underscores the importance of aggressive monitoring and multidisciplinary management when complications arise.

Keywords: Neonatal meningitis; Klebsiella pneumoniae; Brain abscess; Hydrocephalus; External ventricular drain; Infant neurosurgery; Cranial destruction; Skin graft