A Case of Klebsiella Endogenous Endophthalmitis Accompanied by Necrotizing Scleral Perforation

ABSTRACT

PURPOSE: We report a case of endogenous endophthalmitis caused by Klebsiella pneumoniae, accompanied by orbital cellulitis and necrotizing scleral perforation secondary to liver abscess. METHODS: A fifty three year old woman patient who had received treatment for uveitis in local ophthalmic clinic for five days was referred to this ophthalmologic department in consultation for uncontrolled ocular pain and eyelid swelling accompanied by proptosis. Ten days before admission, she had already received antibiotic medication at internal medicine clinic for abdominal pain and fever. Since her ocular pain along with exophthalmos and eyelid swelling got worse, she received a whole body examination including blood culture, urine test, chest and abdominal radiologic examination to find out infectious focus. In addition, ultrasonography, computed tomography and aqueous culture for ophthalmic examination were performed. Then she was treated with antibiotic medication via systemic and topical route. RESULTS: The Klebsiella pneumoniae was cultured from vitreous in endogenous endophthalmitis accompanied by orbital cellulitis and necrotizing scleral perforation. Although the inflammation was improved with antibiotic medication, she lost her vision. CONCLUSIONS: From the fact that scleral perforation can be complicated by endogenous bacterial endophthalmitis, it is strongly urged that systemic work up such as radiologic examination and blood test be carried out with caution to detect infectious diseases.