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Klebsiella pneumoniae liver abscess associated with septic endophthalmitis
Abstract:
Metastatic septic bacterial endophthalmitis is a rare, but devastating disease. We encountered seven cases of pyogenic liver abscess associated with septic endophthalmitis during a recent four-year period. The causative organism was a pure culture of Klebsiella pneumoniae. The diagnosis was made by results of a blood culture in seven of the cases, liver aspirate culture in four, and eye contents or conjunctival culture in four. Chest roentgenographic examination showed pulmonary embolization in four patients, purulent meningitis in one patient, and suspicious prostatic abscess in one patient. Despite diligent antibiotic therapy, six patients lost their vision and one had impaired vision. This poor outcome for septic endophthalmitis seems to result from delayed diagnosis and lack of scheduled periocular injections of antibiotics. A combination course of treatment by the internist and ophthalmologist acting aggressively, both diagnostically and therapeutically, is needed in the future. To have seven cases of K pneumoniae liver abscess complicated by septic endophthalmitis during a period of four years in one hospital is very unusual. To our knowledge, it has never been reported in the literature.
Insights
Pyogenic liver abscesses caused by Klebsiella pneumoniae can lead to metastatic septic bacterial endophthalmitis. This rare condition often results in vision loss, highlighting the need for prompt diagnosis and treatment.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Hepatology
Background:
- Metastatic septic bacterial endophthalmitis is a rare and severe ocular disease.
- Pyogenic liver abscesses are a potential source of systemic infection.
Observation:
- Seven cases of pyogenic liver abscess associated with Klebsiella pneumoniae and septic endophthalmitis were identified over four years.
- Klebsiella pneumoniae was the sole causative organism identified in all cases.
- Diagnosis involved blood, liver aspirate, and ocular cultures.
Findings:
- Pulmonary embolization, meningitis, and prostatic abscesses were noted comorbidities.
- Despite aggressive antibiotic treatment, vision loss occurred in six patients, with one experiencing impaired vision.
- Delayed diagnosis and lack of periocular antibiotic injections contributed to poor visual outcomes.
Implications:
- Early and aggressive combined diagnostic and therapeutic approaches by internists and ophthalmologists are crucial.
- This case series highlights an unusual and previously unreported association between K. pneumoniae liver abscess and septic endophthalmitis.
- Improved management strategies are needed to prevent vision loss in this devastating condition.