University of Calgary
An otherwise healthy 43 year old female, originally from the Phillipines, living in Calgary for 38 years, presented to Emergency Department with a fever and flu- like symptoms. Blood cultures were positive for Klebsiella Pneumoniae. The patient was found to have a liver abscess, pneumonia and was started on Intravenous (IV) Ceftriaxone 1 gram BID. One week after admission to the hospital she began to notice decreased vision in her left eye. On ophthalmic evaluation her BCVA was 20/20 in the right eye and HM in the left eye. SLE of the left eye revealed an anterior chamber reaction of 1+ cells and 2+ vitriitis. Fundus examination of the same eye revealed a large chorioretinal abscess with hemorrhages affecting the macula. Right eye exam was remarkable for a cotton wool spot. The Ceftriaxone IV dosage was doubled and an intravitreal injection of Ceftazidime 2.25 mg/0.1 cc was administered. Nine days post-injection she had significant improvement of the chorioretinal abscess, however there was notable macular atrophy with Count Fingers as visual acuity.
Klebsiella species are gram-negative, encapsulated, anaerobic bacteria that are present in the normal nasopharyngeal and gastrointestinal flora. They are known to cause pneumonia and urinary tract infections. In recent years Klebsiella species have emerged as a prevalent cause of pyogenic liver abscesses in Asia. The reason for the predominance of this syndrome in the Asian population is unclear. It is associated with a 3 –11% incidence of endogenous endophthalmitis. This rate of ocular involvement is notably higher than with other systemic infections.
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