Endogenous Endophthalmitis Due to Klebsiella ozaenae

Iris Na Heah Kim; Song Mi Moon; Mi Jung Chi

doi:10.3341/jkos.2016.57.7.1139

Journal List > J Korean Ophthalmol Soc > v.57(7) > 1010345

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Kim, Moon, and Chi: Endogenous Endophthalmitis Due to Klebsiella ozaenae

Case Report

J Korean Ophthalmol Soc 2016;57(7):1139-1143.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.7.1139

Endogenous Endophthalmitis Due to Klebsiella ozaenae

Iris Na Heah Kim, MD¹, Song Mi Moon, MD², Mi Jung Chi, MD, PhD^1,

¹Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea

²Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea

Address reprint requests to Mi Jung Chi, MD, PhD Department of Ophthalmology, Gachon University Gil Medical Center, #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358 E-mail: cmj@gilhospital.com

Received 27 August 2015 Accepted 16 January 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Endogenous endophthalmitis, Klebsiella ozaenae

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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.

Figure 2.

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

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.

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