Endogenous <em>Klebsiella Pneumoniae</em> Endophthalmitis in a Diabetic Patient

Case Report

Austin J Clin Case Rep. 2015; 2(3): 1075.

Endogenous Klebsiella Pneumoniae Endophthalmitis in a Diabetic Patient

Bazoukis G¹*, Boukas K¹, Fytrakis N¹, Florou K¹, Spiliopoulou A¹, Kaperda A¹, Thrappas J¹, Bazoukis X¹, Bakouli A², Savvanis S¹, Fragkou A¹, Yalouris A¹

¹Department of Internal Medicine, General Hospital of Athens “Elpis”, Greece

²Department of Ophthalmology, General Hospital of Athens “Elpis”, Greece

*Corresponding author: George Bazoukis, Department of Internal Medicine, General Hospital of Athens (Elpis) Greece, Dimitsanas 7, Ambelokipi, Athens, Greece

Received: June 24, 2015; Accepted: September 01, 2015; Published: September 09, 2015

Abstract

Endogenous Klebsiella Pneumoniae endophthalmitis is considered a rare complication of gram negative sepsis. Despite immediate management, the visual outcome of patients with endogenous K. Pneumoniae endophthalmitis is poor ranging from hand motion visualization to evisceration or enucleation of the eye. To the best of our knowledge, we present the first reported case in Greece and among the few reported cases in Europe of a diabetic patient with endogenous K. Pneumoniae endophthalmitis.

Keywords: Endogenous endophthalmitis; Klebsiella Pneumoniae; Leftsided endopthalmitis; Multifocal pneumonia

Abbreviations

EKE: Endogenous Klebsiella Pneumoniae Endopthalmitis

Introduction

Endogenous bacterial endophthalmitis is a rare entity that accounts for 2–15% of all cases of endophthalmitis [1]. Endogenous Klebsiella Pneumoniae endophthalmitis (EKE) is considered a rare complication of gram negative sepsis [2]. A significant increase of EKE in Asia has been reported [2,3]. Although that condition is more prevalent in Asia, cases of K. Pneumoniae liver abscess with endophthalmitis have been also reported in the USA, Australia, Spain, UK and the Middle East [4]. Conditions like intravenous drug abuse, treatment with immunosuppressive agents and diabetes mellitus predispose patients to the disease [5]. The primary sources of EKE infection are suppurative liver disease (68%) or urinary tract infection (16%) [2]. Ten percent of pyogenic K. Pneumoniae liver abscess cases are complicated by EKE [5]. However, the presence of EKE with only bilateral pulmonary infiltrations has rarely been reported [1]. Despite immediate management, the visual outcome in patients with EKE is poor and it ranges from hand motion visualization to evisceration or enucleation of the eye [5].

To the best of our knowledge, we present the first reported case in Greece and among the few reported cases in Europe of a diabetic patient with endogenous K. Pneumoniae endophthalmitis.

Case Presentation

A 55-year-old man from Greece was admitted at the emergency department of our hospital for a 10-day history of fever and cough. He has been empirically treated with Amoxicillin-Clavulanic acid for a week without significant improvement of the symptoms. In addition to that the patient reported redness with concomitant pain and a sudden decrease of the visual acuity of the left eye starting the last 24 hours. He did not mention a recent travel abroad. His medical history included a 6 years history of diabetes mellitus without receiving any medication and hypertension treated with atenolol and irbesartan/hydrochlorothiazide combination.

On admission the patient was febrile. On clinical examination, there was a mild periorbital edema with chemosis of the left eye. The ophthalmological examination showed a significant impairment of the visual acuity limited to “light perception” while the slit lamp examination revealed hypopyon 3,0 mm. The right eye was free of any pathology. Chest x-ray showed the presence of bilateral diffuse lung infiltrates.

Initial blood results showed raised inflammatory markers with white blood cells count (WBC) of 23.900/μL (neutrophil count of 20.600/μL) and C-reactive protein of 18, 20 mg/dl. The random blood glucose levels were 489 mg/dl while the HbA1C was 12, 50%. Other findings were: serum creatinine: 1,3mg/dl, serum sodium: 128mmol/l, serum potassium: 5,0mmol/l, alanine aminotransferase (ALT): 46 U/l, aspartate aminotransferase (AST): 40 U/l and total bilirubin: 1,10mg/dl. The arterial blood gases were within normal values. Our patient was HIV negative and there was no evidence of urinary tract infection.

The blood cultures were positive for K. Pneumoniae (Table 1) while the chest computed tomography scan (CT scan) showed multiple cavitary lesions and nodules of various sizes (Figure 1). The abdominal CT scan did not reveal pathological findings. Transthoracic echocardiogram did not show valvular vegetations. As a result the patient was diagnosed with endogenous K. Pneumoniae endophthalmitis secondary to a systemic infection.

Citation: Bazoukis G, Boukas K, Fytrakis N, Florou K, Spiliopoulou A and Kaperda A, et al. Endogenous Klebsiella Pneumoniae Endophthalmitis in a Diabetic Patient. Austin J Clin Case Rep. 2015; 2(3): 1075. ISSN : 2381-912X