Hypermucoviscous Klebsiella corneal abscess: Infection from inside out

BackgroundCorneal ulcers are typically caused by external ("exogenous") factors such as trauma, contact lens use, or preexisting ocular surface diseases. Internal systemic ("endogenous") sources have not been reported as direct causes of corneal ulcers. Here, we report, to our knowledge, the first documented case of a corneoscleral abscess that resulted from an underlying bacteremia.MethodThis is a single case report.ResultA previously healthy 35-year-old male presented to the Emergency Department with left eye redness, pain, and blurred vision. Initial examination showed reduced visual acuity (20/150), elevated intraocular pressure (44mmHg), diffuse microcystic corneal edema with mutton-fat keratic precipitates, and anterior chamber cells. No corneal infiltrate, epithelial defect, hypopyon, or vitritis was noted. Within days, his condition rapidly progressed to a corneoscleral abscess with auto-evisceration. Blood and corneal cultures identified hypermucoviscous Klebsiella pneumoniae. Further workup revealed an underlying prostatic abscess with secondary iliac vein thrombus, leading to seeding of other sites, including the lungs and the eye. Despite intensive antibiotic therapy, the ocular condition worsened, requiring urgent left eye evisceration.ConclusionThis case highlights the rapid progression of hypermucoviscous Klebsiella pneumoniae infection, which first presented with endophthalmitis, followed by corneoscleral perforation.