Infect Chemother.  2011 Dec;43(6):485-489. 10.3947/ic.2011.43.6.485.

A Case of Renal Abscess associated with endogeneous endophthalmitis and septic pulmonary embolism by Klebsiella pneumoniae

Affiliations
  • 1Divisions of Endocrinology, Department of Internal Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea. hka1114@eulji.ac.kr
  • 2Department of Ophthalmology, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea.

Abstract

Klebsiella pneumoniae is a pathogen that causes a wide range of infections in the human body and has a tendency to metastasize to multiple organs. Endogenous Klebsiella endophthalmitis is an infrequent but often devastating septic metastatic infection. It tends to be fulminant and often rapidly progresses to permanent visual loss beyond 24 hours after symptom onset, despite therapy with appropriate antibiotics, particularly with a delay in diagnosis and treatment. While endogenous Klebsiella endophthalmitis has mostly been reported in association with primary liver abscesses, it has rarely been reported with other Klebsiella infections including renal abscesses. Here, we present a case of a 73-year-old diabetic female diagnosed with a Klebsiella renal abscess and endogenous endophthalmitis, after developing left flank pain and bilateral decreased visual acuity. She was treated with systemic antibiotics, percutaneous abscess drainage, an intravitreal antibiotics injection, and a vitrectomy. While the renal abscess slowly resolved, the symptoms of endophthalmitis persisted despite treatment. This report suggests that endogenous endophthalmitis should be considered when diabetic patients with renal abscesses complain of ocular symptoms.

Keyword

Abscess; Klebsiella pneumoniae; Endophthalmitis

MeSH Terms

Abscess
Aged
Anti-Bacterial Agents
Drainage
Endophthalmitis
Female
Flank Pain
Human Body
Humans
Klebsiella
Klebsiella Infections
Klebsiella pneumoniae
Liver Abscess
Pulmonary Embolism
Visual Acuity
Vitrectomy
Anti-Bacterial Agents

Figure

  • Figure 1 A B-scan orbital ultrasonogram shows a dense vitreous solution with high opacity and multiple abnormal vitreous spikes in the both eyes.

  • Figure 2 (A) Initial abdominal CT scan reveals Lt. APN with an air-containing abscess (7.5 cm) with perinephric infiltration and fluid (arrow). (B) Initial chest CT scan reveals multiple nodules in both lungs, suggestive of a septic embolism (arrow). (C, D) Follow-up CT scan after 4 weeks reveals interval resolution of inflammatory lesion.


Reference

1. Seo JG, Park JC, Ahn HD, Lee SY, Kim JY, Park YS, Cho YK. Klebsiella pneumoniae multi-organ infection not accompanied by liver abscess : report of 2 cases. Infect Chemother. 2008. 40:346–349.
Article
2. Lee IH, Kim TW, Kang GW, Park YC, Kim KH, Kim YY. A case of endogenous Klebsiella endophthalmitis associated with acute pyelonephritis in a patient with chronic renal failure. Korean J Nephrol. 2009. 28:253–258.
3. Oh TS, Ahn Y, Chang SD, Lee YK. A case of endogenous endophthalmitis caused by Klebsiella pneumoniae from emphysematous pyelonephritis. J Korean Ophthalmol Soc. 2002. 43:1330–1334.
4. Jung TS, Kim GW, Koh JI, Yang WJ, Kim TH, Choi KS, Song YS, Park YH. Endogenous Klebsiella endophthalmitis concurrent with prostate and perianal abscesses. Korean J Urol. 2008. 49:1055–1057.
Article
5. Jackson TL, Eykyn SJ, Graham EM, Stanford MR. Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases. Surv Ophthalmol. 2003. 48:403–423.
Article
6. Cheng DL, Liu YC, Yen MY, Liu CY, Wang RS. Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients. Arch Intern Med. 1991. 151:1557–1559.
Article
7. Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL, Chang SC. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis. 2007. 45:284–293.
Article
8. Wang JH, Liu YC, Lee SS, Yen MY, Chen YS, Wang JH, Wann SR, Lin HH. Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 1998. 26:1434–1438.
Article
9. Stotka JL, Rupp ME. Klebsiella pneumoniae urinary tract infection complicated by endophthalmitis, perinephric abscess, and ecthyma gangrenosum. South Med J. 1991. 84:790–793.
10. Okada AA, Johnson RP, Liles WC, D'Amico DJ, Baker AS. Endogenous bacterial endophthalmitis. Report of a ten-year retrospective study. Ophthalmology. 1994. 101:832–838.
11. Joondeph BC, Flynn HW Jr, Miller D, Joondeph HC. A new culture method for infectious endophthalmitis. Arch Ophthalmol. 1989. 107:1334–1337.
Article
12. Greenwald MJ, Wohl LG, Sell CH. Metastatic bacterial endophthalmitis: a contemporary reappraisal. Surv Ophthalmol. 1986. 31:81–101.
Article
13. Yoon YH, Lee SU, Sohn JH, Lee SE. Result of early vitrectomy for endogenous Klebsiella pneumoniae endophthalmitis. Retina. 2003. 23:366–370.
Article
14. Israel DS, Stotka J, Rock W, Sintek CD, Kamada AK, Klein C, Swaim WR, Pluhar RE, Toscano JP, Lettieri JT, Heller AH, Polk RE. Effect of ciprofloxacin on the pharmacokinetics and pharmacodynamics of warfarin. Clin Infect Dis. 1996. 22:251–256.
Article
15. Ness T, Pelz K, Hansen LL. Endogenous endophthalmitis: microorganisms, disposition and prognosis. Acta Ophthalmol Scand. 2007. 85:852–856.
Article
16. Sung KR, Lee YB, Kim CH, Sohn JH, Yoon YH. Clinical aspects of infectious endogenous endophthalmitis. J Korean Ophthalmol Soc. 1999. 40:176–181.
17. Sheu SJ, Kung YH, Wu TT, Chang FP, Horng YH. Risk factors for endogenous endophthalmitis secondary to klebsiella pneumoniae liver abscess: 20-year experience in Southern Taiwan. Retina. 2011. 31:2026–2031.
Article
18. Ang M, Jap A, Chee SP. Prognostic factors and outcomes in endogenous Klebsiella pneumoniae endophthalmitis. Am J Ophthalmol. 2011. 151:338–344.
Full Text Links
  • IC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr