Abstract
Endogenous Klebsiella pneumoniae panophthalmitis commonly affects those with compromised immunity. The occurrence of this infection in healthy individuals is rare. We describe the case of a healthy adult who presented with endogenous Klebsiella pneumoniae panophthalmitis from an asymptomatic liver abscess.A 64-year-old, previously healthy gentleman presented with rapidly progressive left eye periorbital swelling and blurring of vision. He had a low-grade fever three days prior to the development of ocular symptoms, but otherwise no other systemic complaints. Visual acuity was light perception in the left eye, and ocular motility was restricted in all directions of gaze. Ocular examination revealed proptosis, severe conjunctival chemosis, hazy cornea, and fibrin deposition in the anterior chamber. The posterior segment could not be visualized.Ultrasound of the hepatobiliary system revealed an abscess in the right lobe of his liver. His blood cultures grew Klebsiella pneumoniae. Despite being treated with high-dose intravenous antibiotics, his eye condition deteriorated. Evisceration was performed when he developed scleral melting and globe perforation.We highlight the importance of a high index of suspicion of endogenous Klebsiella panophthalmitis as it can be easily missed in healthy adults. Early diagnosis and prompt management are needed to prevent morbidity and mortality from this devastating infection.
Highlights
Endogenous Klebsiella pneumoniae panophthalmitis is an emerging entity in South East Asia
We describe the case of a healthy adult who presented with endogenous Klebsiella pneumoniae panophthalmitis culminating in orbital apex syndrome and poor outcome for the eye
Our patient was compliant with his wound dressing schedules. He achieved good wound healing without the need for secondary suturing. This case report demonstrates the devastating manifestation of Klebsiella pneumoniae infection in a healthy adult with no comorbidities
Summary
Endogenous Klebsiella pneumoniae panophthalmitis is an emerging entity in South East Asia. Prompt diagnosis with early identification of the source of infection followed by targeted treatment may, salvage useful vision. We describe the case of a healthy adult who presented with endogenous Klebsiella pneumoniae panophthalmitis culminating in orbital apex syndrome and poor outcome for the eye. A 64-year-old gentleman who had no known comorbidity presented with sudden-onset, progressive left eye periorbital swelling It was associated with blurring of vision, redness, and pain. Full blood count showed a raised white cell count of 18.6 × 109/L, with neutrophils predominating His total bilirubin level was 262umol/L, slightly raised above the normal range. Surgical and infectious disease services were consulted to assist in the patient’s management His eye condition deteriorated despite the aggressive treatment. At three weeks post-operatively, the wound had healed well without the need for secondary suturing (Figure 6)
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