Klebsiella pneumoniae Endogenous Endophthalmitis in an Active Duty Service Member

Klebsiella pneumoniae Endogenous Endophthalmitis (KPEE) typically presents among those who are immunocompromised or have systemic diseases, leading to visual impairment and other fatal complications. The following case is an immunocompetent, healthy active duty (AD) male with no known risk factors who developed KPEE. A 47-year-old AD male with multiple deployments to Asia experienced fevers, chills, and fatigue and tested positive for COVID. He then began experiencing vision changes before presentation to the Emergency Department. He had a painful right eye and vision loss, specifically a deficit in the right temporal visual field. Orbital MRI revealed endophthalmitis concerning for infectious etiology. Blood cultures revealed K. pneumoniae. Elevated liver-associated enzymes and concern for an abdominal source of K. pneumoniae prompted abdomen CT showing complex hepatic hypodensities. Biopsy of these abscesses also grew K. pneumoniae. It is speculated that K. pneumoniae from these abscesses seeded to the blood, which then seeded to his right eye. K. pneumoniae liver abscesses are associated with a 3%-11% incidence of endogenous endophthalmitis with predominance in Asia. Risk factors include diabetes, alcoholism, and immunocompromise. With deployments to Asia, it is possible that this patient was exposed to a hypervirulent strain of K. pneumoniae. His COVID infection and subsequent immunocompromise may have predisposed him to systemic K. pneumoniae. Although KPEE typically occurs in patients from Asia, it is possible that our ADs who deploy to Asia may be exposed to strains of virulent K. pneumoniae. However, more studies need to be done as the evidence is limited.