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M. Mayers, A.M. Roberts, B.F. Mason; Endogenous Bilateral Klebsiella Endophthalmitis in Asymptomatic Caribbean Man . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5571.
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To report a rare case of bilateral endogenous Klebsiella endophthalmitis from silent pyogenic liver abscess in an asymptomatic African–Caribbean man
Clinical case report
A healthy 59–year–old man on treatment for primary open angle glaucoma and systemic hypertension developed a sudden and rapid deterioration of vision sequentially in each eye over 48 hours. Because of the anterior hypopyon findings, he was initially treated as an autoimmune uveitis with topical and oral steroids. Seven days after the onset of his ocular symptoms he was admitted to a hospital with fever, leukocytosis and no light perception in either eye. Fulminant panophthalmitis further perforated both corneas. Funduscopy was precluded. Orbital ultrasonography revealed bilateral dense homogenous vitreous debris, with no discernible intraocular structures. Orbital CT showed enhanced thickening of scleral margins, and intraocular swelling of both optic nerves. Cutures of anterior chamber discharge and corneal scraping taked before the start of antibiotics grew Klebsiella pneumonia OU. Intravenous antibiotics were adjusted to levofloxacin and gentamycin. Laboratory levels of lactic dehydrogenase were elevated. Intrahepatic abscess revealed by CT scan was drained, but like blood cultures, was unyielding. Endogenous metastatic Klebsiella endophthalmitis is most common in South Asian diabetic septic patients with liver abscesses. However, it is rare in seemingly healthy asymptomatic non–diabetic patients, non–infectious uveitis is the main misdiagnosis. Our Patient demonstrates that endogenous endophalmitis can be the first manifestation of a silent systemic infection.This case emphasizes three important points for the ophthalmologist: (1) systemically ill patient is not a prerequisite for the diagnosis of endogenous endophthamlmitis; (2) high index for infectious causes of uveitis as new studies show improved prognosis with early proper intervention; (3) when in doubt, manage as infectious prrocess.
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