Endogenous Endophthalmitis Associated with Pyogenic Liver Abscess Caused by <i>Klebsiella pneumoniae</i>

Abstract

We report 2 cases of endogenous endophthalmitis associated with pyogenic liver abscess caused by Klebsiella pneumoniae. Case 1 involved a 70-year-old woman and case 2 involved a 50-year-old man who were admitted to our hospital with diagnoses of liver abscess and endogenous endophthalmitis, respectively. The liver abscess resolved with antibiotics and percutaneous transhepatic drainage in case 1 and with antibiotics alone in case 2. Even though both cases underwent ophthalmic surgery, they were discharged from our hospital without the recovery of their eyesight. An earlier diagnosis and treatment are needed to improve the prognosis of endophthalmitis.

Hypervirulent Klebsiella pneumoniae Endogenous Endophthalmitis—A Global Emerging Disease

“…The entry gate is considered to be the gastrointestinal tract [ 15 ], oropharyngeal [ 67 ], or recent urinary tract infections [ 62 ]. Oropharyngeal colonization could lead to infection with aspiration, but it is still unclear what the mechanism of entry is via the GI tract since many individuals subsequently infected have no apparent GI pathology.…”

“…Chung et al found a significant fecal carriage of K1 and K2 pathogenic stains in stools in a cohort of healthy South Korean residents [ 15 ]. Fujita et al found a correlation with previous treatments with ampicillin or amoxicillin, leading to the hypothesis that these antibiotics may increase the risk for KPLA by selection pressure [ 67 , 68 , 69 ]. Diabetes, by impaired gastrointestinal permeability, may favor bacterial translocation into the portal bloodstream [ 68 , 69 ].…”

“…Diabetes, by impaired gastrointestinal permeability, may favor bacterial translocation into the portal bloodstream [ 68 , 69 ]. In a two-case report, Fujita et al found KPLA and endophthalmitis appeared in patients previously incompletely treated with amoxicillin/clavulanic acid for sore throats and upper respiratory infections and postulated the possibility of systemic dissemination following incomplete eradication of the pathogen [ 67 ].…”

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“…KLA has an overall good prognosis if diagnosed early and treated adequately, but patients with metastatic infection especially endophthalmitis have a poor prognosis and cause significant morbidity [15].…”

Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by liver abscess

“…Endogenous endophthalmitis as a result of liver abscess is caused by the hematogenous spread of pathogenic bacteria from the liver abscess, which passes through the blood–retinal barrier, leading to infection of the eye [ 3 ]. In recent years, many cases have been reported in Asia, with Klebsiella pneumoniae being the most common causative agent [ 4 , 5 ]. Since the disease is relatively occult during the early stage, it can rapidly infect intraocular tissues, resulting in irreversible damage to the photoreceptor cells in the retina.…”