Endogenous Klebsiella Endophthalmitis with Unknown Primary Origin-A Case Report

Abstract

Purpose: To report a non-diabetic patient with endogenous Klebsiella endophthalmitis of unknown infectious focus and to describe the fulminant course despite aggressive therapy. Method: Case report. Results: A 57-year-old non-diabetic woman without significant past medical history presented to the emergency department complaining of loss of vision OD for 1 day. Her best-corrected visual acuity was hand motion OD and 25/20 OS. A slit-lamp examination showed fibrin and inflammatory cells in the anterior chamber, and 360° posterior synechiae OD. B-scan ultrasonography showed dense vitreous opacity OD. General physical, neurological examinations and pertinent laboratory studies were all within normal limits. Computed tomogram of the head and orbits and ultrasound of the liver and heart were non-contributory. A right vitreous biopsy for culture, intravitreal antibiotic injection and pars plana vitrectomy were performed. Gram-stained smears revealed Gram-negative rods, and cultures yielded Klebsiella pneumoniae. A Gallium-67 whole body survey showed intense Ga-67 activity accumulation only in the right eye region. Despite aggressive treatment, vision still declined to no light perception. No other signs of sepsis developed. The left eye was not involved. Conclusion: This case shows that Klebsiella endophthalmitis may occur even in patients without diabetes or obvious systemic infection. In Taiwan, community-acquired Klebsiella pneumoniae bacteremia has emerged as substantial public health problem. It’s important to educate doctors and patients not to abuse antibiotics. Familiarity with endogenous Klebsiella endophthalmitis would aid in early differentiation from noninfectious uveitis and institution of appropriate antibiotic therapy.