J Korean Ophthalmol Soc.  2017 Nov;58(11):1301-1306. 10.3341/jkos.2017.58.11.1301.

An Unusual Case of Endogenous Klebsiella Pneumonia Endophthalmitis

• Jung SI
• Han JS
• Yang JH
• Kim DG

• KMID: 2395874
• DOI: http://doi.org/10.3341/jkos.2017.58.11.1301

Abstract

PURPOSE
To report an unusual case of endogenous endophthalmitis in a patient with Klebsiella pneumoniae primary liver abscess.
CASE SUMMARY
A-54-year-old man with diabetes mellitus and liver abscess was referred to us for consultation of visual loss in his left eye for 2 days. On the first examination, the patient's left visual acuity was hand motion and the left intraocular pressure was 13 mmHg. Vitreous opacity and inflammatory membrane were detected with increased echogenicity using ultrasonography. Vitectomy and intravitreous antibiotic injection were performed under the impression of endogenous endophthalmitis caused by liver abscess on the day of the first visit. Culture revealed Klebsiella pneumoniae from blood and liver abscess. After vitrectomy, the patient showed improvement. However, on the 20th and 40th postoperative days, the patient complained of blurred vision, and inflammation and hypopyon were observed in the anterior chamber. An intracameral antibiotic injection and anterior chamber washing were performed. The patient has not complained of any other symptoms to date.
CONCLUSIONS
In this patient with endophthalmitis, inflammation and hypopyon in the anterior chamber were evident three times after vitrectomy. Ultimately, the inflammation was effectively controlled by intracameral antibiotic injection and anterior chamber washes.

Keyword

Endogenous endophthalmitis; Hypopyon; Klebsiella pneumoniae; Liver abscess

MeSH Terms

Anterior Chamber
Diabetes Mellitus
Endophthalmitis*
Hand
Humans
Inflammation
Intraocular Pressure
Klebsiella pneumoniae
Klebsiella*
Liver Abscess
Membranes
Pneumonia*
Ultrasonography
Visual Acuity
Vitrectomy

Figure

• 

  Figure 1 Abdominal computed tomography finding at the day of admission. Low attenuated 5 cm-sized mass was found at the right of the liver, consistent with liver abscess.

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  Figure 2 Anterior photographs at the first visit. (A) Conjunctival hyperemia and hypopyon are seen in the left eye. (B) Inflammatory cells and membrane are seen in the anterior chamber of the left eye.

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  Figure 3 Ultrasonographs at the first visit. (A) Ultrasonography reveals inflammatory membrane and suspicious retinal detachment. (B) Ultrasonography reveals inflammatory membrane.

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  Figure 4 Anterior photographs at the 1st day of vitrectomy. Conjunctival hyperemia and hypopyon are seen in the left eye.

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  Figure 5 Anterior photographs at the 20th day of vitrectomy. Slight hypopyon are seen in the left eye.

• 

  Figure 6 Anterior photographs at the 40th day of vitrectomy. Slight hypopyon are seen in the left eye.

• 

  Figure 7 Fundus photographs at the 7th day of vitrectomy. Left eye shows slightly hazy fundus due to silicone oil but flat posterior pole.

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