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Jung, Han, Yang, and Kim: An Unusual Case of Endogenous Klebsiella Pneumonia Endophthalmitis
Case Report

Journal of the Korean Ophthalmological Society 2017; 58(11): 1301-1306.

Published online: 15 November 2017

DOI: https://doi.org/10.3341/jkos.2017.58.11.1301

An Unusual Case of Endogenous Klebsiella Pneumonia Endophthalmitis

Seung Il Jung, MD, Ji Sang Han, MD, Ji Ho Yang, MD, Do Gyun Kim, MD, PhD

Department of Ophthalmology, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea.

Address reprint requests to Do Gyun Kim, MD, PhD. Department of Ophthalmology, Myongji Hospital, #55 Hwasu-ro 14beon-gil, Deogyang-gu, Goyang 10475, Korea. Tel: 82-31-810-6250, Fax: 82-31-810-0500, Kimdk89@empas.com

Received 30 March 2017       Revised 28 August 2017       Accepted 19 October 2017

©2017 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

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 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.

Keywords: Endogenous endophthalmitis, Hypopyon, Klebsiella pneumoniae, Liver abscess

Figures and Tables

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.

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Figure 6

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

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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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Notes

Conflicts of Interest The authors have no conflicts to disclose.

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