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The invasive Klebsiella pneumoniae syndrome: Case series
Radtthiga Chelvaraj1, Tinesh Thamotaran1, Cheong M Yee2
1Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Malaysia.
Abstract:
This case-series aims to report three cases of endogenous endophthalmitis due to invasive Klebsiella pneumoniae syndrome.
Case 1:
A 34-year-old lady who was admitted for pneumonia developed painful blurring of vision and redness in the right eye (RE) for one week. An examination of the RE revealed visual acuity (VA) of light perception (PL) with positive relative afferent pupillary defect (RAPD), proptosis, and restriction of extraocular movement with hypopyon. The patient was treated for RE panophthalmitis with a lung abscess and was started on systemic and topical antibiotics. The vitreous tap culture grew Klebsiella pneumoniae. Despite treatment, the patient's condition deteriorated, and evisceration was undertaken.
Case 2:
A 38-year-old lady presented with a acute onset of RE pain associated with blurred vision and redness for two days, and fever for one week. RE VA was hand movement with a positive RAPD and anterior chamber cells of 2+. A B-scan revealed a dome-shaped subretinal mass with exudative retinal detachment. The patient was treated for RE panophthalmitis complicated by a basal ganglia abscess. The urine and vitreous tap cultures grew Klebsiella pneumoniae. She responded to high-dose intravenous and intravitreal antibiotics. Unfortunately, her RE became phthisical.
Case 3:
A 70-year-old lady presented with painless blurring of vision over the RE. The blood and urine cultures grew Klebsiella pneumoniae. RE VA was PL, and she was treated for endogenous endophthalmitis. The vitreous culture grew Klebsiella pneumoniae. Unfortunately, the RE became phthisical.
Insights
Invasive Klebsiella pneumoniae can cause severe endogenous endophthalmitis, leading to vision loss. Prompt diagnosis and aggressive treatment are crucial for managing this sight-threatening infection.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Endogenous endophthalmitis is a serious intraocular infection.
- Invasive Klebsiella pneumoniae syndrome is a rapidly progressive condition.
Observation:
- Three cases of endogenous endophthalmitis caused by Klebsiella pneumoniae are presented.
- Patients experienced severe vision loss, pain, and redness, with some developing associated abscesses.
- Ocular findings included hypopyon, proptosis, and retinal detachment.
Findings:
- Klebsiella pneumoniae was identified in vitreous, blood, and urine cultures across all cases.
- Despite treatment with systemic and topical antibiotics, outcomes were poor, with vision loss and phthisis bulbi in two cases, and evisceration in one.
- One patient showed improvement with high-dose intravenous and intravitreal antibiotics.
Implications:
- Highlights the aggressive nature of Klebsiella pneumoniae in endogenous endophthalmitis.
- Emphasizes the need for early recognition and aggressive management strategies.
- Suggests potential challenges in achieving favorable visual outcomes even with prompt treatment.
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