Optic neuritis after Klebsiella pneumonitis and liver abscess

A 56-year-old woman developed a left optic neuropathy in the context of a Klebsiella pneumonitis that had also produced a liver abscess. Ophthalmic examination was normal apart from no light perception vision in the left eye and a left afferent pupil defect. Orbit and brain MRI revealed enhancement of the left optic nerve and several round enhancing areas in the gray-white junction of the frontal and temporal lobes consistent with microabscesses. Although the patient recovered systemically with antiinfective and corticosteroid treatment, she retained no light perception vision in the left eye 4 months later. The association of Klebsiella pneumonitis and optic neuritis has not been described previously. We presume that the organisms spread hematogenously.