Unusual Clinical Presentation of Klebsiella Pneumoniae Induced Endogenous Endophthalmitis and Xanthogranulomatous Pyelonephritis in a Non-Nephrolithiasis and Non-Obstructive Urinary Tract

Abstract

The genitourinary tract is well recognized as a route through which bacteria could gain access to the blood circulation. Under some circumstances, metastatic infections may occur in distant organs, including endogenous endophthalmitis. Xanthogranulomatous pyelonephritis (XGP) is an unusual variant of chronic pyelonephritis. It most often occurs in middle-aged women who frequently have a history of recurrent urinary tract infections combined with obstruction and a kidney of poor function. We reported an unusual case of urinary tract infection in a non-nephrolithiasis and non-obstructive urinary tract complicated by Klebsiella pneumoniae endogenous endophthalmitis and developed XGP in two months.

Endogenous endophthalmitis in Klebsiella pneumoniae pyogenic liver abscess: Systematic review and meta-analysis

“…Examination of this association from the opposite direction also confirms that most patients in whom EE is diagnosed also have KPPLA as the source of infection (Jackson et al, 2014). While it is true that EE can occasionally arise from other infectious foci of metastatic K. pneumoniae, such as perinephric abscess (Takebayashi et al, 2005), pyelonephritis (Lin et al, 2002), and pneumonia (Ang et al, 2000), KPPLA remains the predominant cause (Jackson et al, 2014). Moreover, the visual outcome of EE often remains poor despite aggressive therapy, often necessitating evisceration or resulting in permanent visual loss.…”

An unusual case of xanthogranulomatous pyelonephritis in an immunosuppressed patient with systemic lupus erythematosus

“…The occurrence of XGP has rarely been reported in the absence of obstruction and nephrolithiasis, albeit in concurrence with other metastatic infective foci [11]. In our case other infective foci were not evident.…”

Endogenous Klebsiella pneumoniae endophthalmitis with renal abscess: Report of two cases

“…12 Several risk factors such as renal stones, recurrent urinary tract infections, structural abnormalities of the urinary tract, history of urologic surgery, trauma, and diabetes mellitus have been identified in patients with perinephric and renal abscesses. [8][9][10][11][12] However, the only risk factor in these two patients was diabetes mellitus.…”

“…[3][4][5][6][7] However, the other infectious causes of EKE have been underestimated, such as renal and perinephric abscesses. [8][9][10][11] Thus, the disease usually results in a poor visual outcome, and salvageable vision is limited to eyes that are diagnosed and treated early. 5 Herein, we report two cases of EKE with either perinephric or renal abscess.…”