Four cases of endogenous Klebsiella endophthalmitis in Los Angeles County: A case series

Klebsiella pneumoniae (K. pneumoniae) represents a frequent cause of endogenous endophthalmitis in East Asia but remains an uncommon cause of endogenous endophthalmitis in the United States. Recent reports have characterized the emergence of hypervirulent K. pneumoniae strains, which are now thought to be the predominant cause of endogenous K. pneumoniae endophthalmitis. We document four cases of endogenous Klebsiella endophthalmitis in Los Angeles County from 2022 to 2024, including two cases confirmed secondary to a hypervirulent strain. The first two cases occurred in diabetic females with associated renal abscesses. While both patients were initially treated with systemic and intravitreal antibiotics, they ultimately required evisceration or enucleation. The third case occurred in a 54-year-old diabetic male, who presented with panophthalmitis of the left eye, subsequently found to have multiple hepatic abscesses. Our final case occurred in a 47-year-old diabetic male with bilateral endogenous endophthalmitis and disseminated cerebral, pulmonary, and hepatic abscesses consistent with K. pneumoniae invasive syndrome. Both the latter two patients were treated with intravitreal and systemic antibiotics, followed by vitrectomy. These cases underscore the importance of recognizing endogenous Klebsiella endophthalmitis as a potential complication in diabetic patients and its association with both hepatic and renal abscesses, as prompt systemic workup may facilitate timely diagnosis and intervention.