Endogenous endophthalmitis and liver abscess due to presumed-Hypervirulent Klebsiella pneumoniae: a case report.

Abstract

Pyogenic liver abscess is a high-incidence disease, in which hypervirulent (hypermucoviscous) Klebsiella pneumoniae (KP) has become more relevant due to its ability to spread and infect other tissues, among which endogenous endophthalmitis (EE) is the most common complication. A patient with right-sided abdominal pain, vomiting, anorexia, fever, and jaundice was diagnosed with a KP liver abscess that was drained and treated with ampicillin/sulbactam plus metronidazole. Subsequently, he had a recurrence of the liver abscess plus rapidly progressive ocular symptoms that raised suspicion of EE. Due to the severity of the infection, eye enucleation was required and despite the natural resistance pattern, the patient only improved after meropenem was prescribed. Any ocular symptoms in patients with KP liver abscess should raise suspicion of EE, contributing to an early diagnosis and treatment. It is possible that despite the antibiogram results, only broad-spectrum antibiotics may avoid vision loss and improve clinical outcomes.