J Korean Ophthalmol Soc.  2016 Jul;57(7):1139-1143. 10.3341/jkos.2016.57.7.1139.

Endogenous Endophthalmitis Due to Klebsiella ozaenae

• Kim IN
• Moon SM
• Chi MJ

• KMID: 2317576
• DOI: http://doi.org/10.3341/jkos.2016.57.7.1139

Abstract

PURPOSE
To report a case of endogenous endophthalmitis due to Klebsiella ozaenae, which is a rare causative organism of endophthalmitis.
CASE SUMMARY
A 61-year-old male who was undergoing chemotherapy for hepatocellular carcinoma complained of sudden visual loss and ocular pain in his left eye for 2 days. On the first examination, the patient's visual acuity was counting fingers at 10 cm and the intraocular pressure was elevated to 29 mm Hg. Partial scleral rupture and choroidal prolapse were observed. Subretinal abscess was detected with increased echogenicity using ultrasonography. The patient complained of burning sensation on voiding and urinary frequency; subsequent urinalysis showed pyuria and bacteriuria. Intravitreal and systemic antibiotics were administered under the impression of endogenous endophthalmitis caused by urinary tract infection. Despite treatment, visual acuity decreased to no light perception in 4 days and intraocular pressure and pain was uncontrollable. Enucleation was performed and pus culture from the eye during surgery revealed Klebsiella ozaenae.
CONCLUSIONS
Klebsiella ozaenae is a rare causative organism of endophthalmitis and shows a rapid progress and poor prognosis. Endogenous endophthalmitis must be highly suspected in patients with urinary tract infection as well as pyogenic liver abscess.

Keyword

Endogenous endophthalmitis; Klebsiella ozaenae

MeSH Terms

Abscess
Anti-Bacterial Agents
Bacteriuria
Burns
Carcinoma, Hepatocellular
Choroid
Drug Therapy
Endophthalmitis*
Fingers
Humans
Intraocular Pressure
Klebsiella*
Liver Abscess, Pyogenic
Male
Middle Aged
Prognosis
Prolapse
Pyuria
Rupture
Sensation
Suppuration
Ultrasonography
Urinalysis
Urinary Tract Infections
Visual Acuity
Anti-Bacterial Agents

Figure

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  Figure 1. External appearance of the patient. Left eyelid edema with severe conjunctival and subconjunctival hemorrhages, and scleral perforation with choroidal exposure (arrow) are shown.

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  Figure 2. B-scan ultrasonography finding. B-scan sonogram shows increased echogenicity into the eyeball implying subretinal abscess (arrows).

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  Figure 3. Orbital computed tomography (CT) findings. Axial orbital CT scan shows the protruded left globe. Thickened sclera and high density within the retroorbital space suggests infective or inflammatory process.

Reference

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