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Bilateral Endogenous Klebsiella pneumoniae Endophthalmitis in a Patient Undergoing Liver Transplantation: A Case Report and Review of Literature
Endophthalmitis is a severe intraocular infection that can lead to vision loss or blindness. In most cases, it is exogenous, meaning that the infection is introduced from an external source. However, endogenous endophthalmitis can also occur, where the infection spreads to the eye from a distant primary focus in the body. One of the causative agents of endogenous endophthalmitis is Klebsiella pneumoniae, which is a gram-negative bacterium found in the human gut. In this report, we describe a case of bilateral endogenous Klebsiella pneumoniae endophthalmitis in a patient undergoing liver transplantation.
Case Presentation
The patient was a 60-year-old man who underwent liver transplantation for liver cirrhosis complicated by hepatocellular carcinoma. On the 10th day after transplantation, he developed a fever, which was initially attributed to a urinary tract infection. However, he subsequently developed a decreased level of consciousness and was found to have septic shock. Blood cultures grew Klebsiella pneumoniae, and he was treated with antibiotics.
On the 16th day after transplantation, he complained of visual disturbance and was found to have decreased vision in both eyes. Ophthalmological examination revealed bilateral endophthalmitis with vitreous abscesses. Intravitreal antibiotics were administered, but despite aggressive therapy, his vision did not improve, and he eventually became blind in both eyes.
Discussion
Endogenous endophthalmitis is a rare but serious condition that can occur in immunocompromised patients or those with a distant focus of infection. Klebsiella pneumoniae is an uncommon cause of endogenous endophthalmitis, but it has been reported in patients with liver abscesses or those undergoing liver transplantation. The source of infection in our patient was not identified, but it is possible that the bacteria spread from his gut or urinary tract to the liver and then to the eyes.
Early diagnosis and aggressive treatment are essential for a good visual outcome in endophthalmitis, but the prognosis is guarded, especially in cases of bilateral involvement. In our case, despite prompt treatment, the patient’s vision was irreversibly lost. Therefore, it is essential to consider endophthalmitis in the differential diagnosis of any febrile patient with visual symptoms, especially in those with risk factors such as immunosuppression or chronic liver disease.
