Endogenous Endophthalmitis as a Primary Focus of Klebsiella Pneumoniae Infection-A Case Report

Abstract

Purpose: To report a case of endogenous Klebsiella pneumoniae endophthalmitis as a primary infectious focus in a diabetic patient. Methods: Case report. Results: A 75-year-old diabetic woman had suffered from abrupt visual loss in her left eye for one day without any systemic symptoms. The best-corrected visual acuity was 1/60 and ocular examinations revealed moderate anterior cells and a dense yellowish white vitreal opacity. Under the impression of endogenous endophthalmitis, pars plana vitrectomy and intravitreal injections of antibiotics were performed. Diffue white fluffy nodules in the retina, markedly sheathing arteries and a well-demarcated yellowish subretinal abscess in the inferionasal fundus were found at the time of surgery. This subretinal abscess resulted in a retinal break and proliferative vitreoretinopathy requiring additional operations including retinectomy and silicon oil tamponade. The vitreous culture yielded Klebsiella pneumonia. Despite repeated and thorough systemic check-up including Gallium-67 whole body scan, no other infectious origin was found. Retinal reattachment could be achieved but the best-corrected visual acuity was only finger-counting 6 months postoperatively. Conclusion: Endogenous Klebsiella pneumoniae endophthalmitis could present as a solitary focus that may demand a high index of suspension to diagnose. Early surgical intervention with intravitreal and parenteral antibiotics treatment may be very important to obtain maximal visual potential in this aggressive disease.