Bilateral Endogenous Endophthalmitis as an Initial Presentation of Klebsiella pneumoniae Bacteremia in Advanced Hepatocellular Carcinoma

Abstract

Aims: To report a case of Klebsiella pneumoniae bacteremia presenting as bilateral endogenous endophthalmitis in a patient with advanced hepatocellular carcinoma and liver failure. Presentation of Case: We describe a 55 year-old man with diabetes, Hepatitis B, metastatic hepatocellular carcinoma with liver failure who presented with sudden, painful, bilateral rapid loss of vision accompanied with hypopyon, intense anterior chamber fibrinous reaction and vitritis. Systematic workup revealed bilateral endogenous K. pneumonia endophthalmitis secondary to hepatobiliary sepsis. Conservative management with systemic piperacillin/tazobactam, intravitreal and topical ceftazidime and vancomycin led to successful sepsis control, however visual outcome was dismal. Discussion: Klebsiella endogenous endophthalmitis has become extremely prevalent in southeast Asia, most commonly occurring as a metastatic complication of pyogenic liver abscess. Early systemic and intravitreal antibiotics remain the cornerstone of its management. Despite adequate treatment, visual prognosis is grave. Conclusion: This highlights the rapidly destructive nature of this virulent organism. Clinicians must be mindful that endophthalmitis can be the initial presenting sign of Klebsiella bacteremia and the search for a primary infective source is paramount. Identification of prognostic factors for poor vision following an attack allows early intervention, in hope to improve patient outcomes.