J Korean Ophthalmol Soc.  2019 Dec;60(12):1334-1338. 10.3341/jkos.2019.60.12.1334.

Endogenous Endophthalmitis by Hypervirulent Klebsiella Pneumoniae Invasive Syndrome

Affiliations
  • 1Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Korea. god1048576@naver.com

Abstract

PURPOSE
To report a case of endogenous endophthalmitis with an elbow abscess spread from a liver abscess in a patient with hypervirulent Klebsiella pneumoniae (hvKP) invasive syndrome.
CASE SUMMARY
A 33-year-old healthy male presented with painless visual loss in his right eye. He experienced pain, a febrile sensation, and swelling in his right elbow for 1 week prior. He had no trauma history. Many inflammatory cells, hypopyons, and cyclitic membranes were present in the anterior chamber of the eye but no ocular injection was performed. With a provisional diagnosis of panuveitis, topical antibiotics, steroid, and cycloplegics were administered and subtenon triamcinolone was injected. After orthopedic consultation, an elbow abscess was suspected and surgery was performed. Two days after the surgery, the patient experienced ocular pain and an injection was performed. Fever, chill, and acute deterioration of his general condition were noted which suggested infective endophthalmitis. Emergency vitrectomy was performed but because subretinal and choroidal abscesses were observed during surgery, the surgery was changed to enucleation. A liver abscess was observed using abdominal computed tomography after transfer to the infection medical department and hvKP was positive in the blood, liver, elbow, and eye cultures.
CONCLUSIONS
A primary liver abscess caused by hvKP occurred in a healthy young man and metastatic infection occurred with endogenous endophthalmitis and a rare elbow abscess. Because hvKP endogenous endophthalmitis has a poor prognosis, rapid diagnosis followed by appropriate treatment is required.

Keyword

Endogenous endophthalmitis; Hypervirulent; Invasive syndrome; Klebsiella Pneumoniae

MeSH Terms

Abscess
Adult
Anterior Chamber
Anti-Bacterial Agents
Choroid
Diagnosis
Elbow
Emergencies
Endophthalmitis*
Fever
Humans
Klebsiella pneumoniae*
Klebsiella*
Liver
Liver Abscess
Male
Membranes
Mydriatics
Orthopedics
Panuveitis
Prognosis
Sensation
Triamcinolone
Vitrectomy
Anti-Bacterial Agents
Mydriatics
Triamcinolone
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