Bilateral Endogenous Klebsiella pneumoniae Endophthalmitis in Culture-Negative Liver Abscess Requiring Evisceration: A Case Report and Review of Literature

Abstract

Endogenous endophthalmitis is a very rare but potentially devastating intraocular inflammation resulting from hematogenous dissemination into the eye from a remote focus of infection. We present a case of a 49year-old Vietnamese gentleman with underlying hypertension and ischemic heart disease who presented with sudden onset bilateral eye blurring of vision for five days associated with fever, chills, and rigors. He started to have a chesty cough with right-sided pleuritic chest pain for three days as well as shortness of breath, which developed one day prior to admission. Bilateral ocular examinations and B-scan ultrasonography were consistent with endophthalmitis. A systemic workup was performed and showed multiloculated liver abscess and right lung empyema seen radiologically. Bilateral eye vitreous tap and intravitreal antibiotic injection were performed. He underwent ultrasound-guided pigtail catheter insertion and drainage of the subcapsular and pelvic collection. Microbiological findings revealed Klebsiella pneumoniae infection obtained from vitreous and endotracheal aspirate samples. There were no cultures yielded from the intraabdominal collection and peripheral blood. The right eye infection rapidly progressed to panophthalmitis, which subsequently led to globe perforation despite prompt treatment and eventually required evisceration. Thus, despite culture-negative pyogenic liver abscess in a non-diabetic patient, a high index of suspicion, emergent radiographic evaluation, and prompt intervention and treatment are crucial in salvaging the globes.