Snapshot A 55-year-old man is brought to the emergency department by police after being found confused in the park. Obtaining a history is difficult. On physical exam, the patient smells of alcohol and has a productive cough of red currant jelly. There are decreased breath sounds in the right lung fields. A chest radiograph is obtained, which demonstrates a lobar consolidation concerning for pneumonia. A sputum culture demonstrates Gram-negative bacilli that are facultative anaerobes and lactose fermenting. They have a mucoid appearance on MacConkey agar. Introduction Classification a gram-negative, lactose-fermenting, facultative anaerobic bacilli Microbiology contains an abundant polysaccharide capsule leading to mucoid colonies Associated conditions granuloma inguinale community-acquired pneumonia lung abscess aspiration pneumonia urinary tract infection invasive liver abscess syndrome Presentation Symptoms/physical exam pneumonia red currant jelly sputum typically seen in patients with diabetes and alcohol use disorder sexually transmitted infection chronic genital ulcers urinary tract infection dysuria urinary frequency urinary urgency suprapubic pain invasive liver abscess right upper quadrant pain Studies Culture obtained from possible sites of infection mucoid and pink colonies on MacConkey agar Treatment Medical third generation cephalosporins, carbapenems, aminoglycosides, and quinolones indication these agents have activity against Klebsiella; however, susceptibility testing will dictate which antibiotic is best Complications Sepsis