Invasive Klebsiella Syndrome with Liver Abscess and Endogenous Endophthalmitis.

Background: Invasive Klebsiella syndrome is an emerging infectious condition that frequently involves pyogenic liver abscess (PLA) and metastatic complications such as endogenous endophthalmitis (EE). This condition is often associated with diabetes mellitus and can result in poor visual prognosis despite treatment.

Case description: We present the case of a 53-year-old diabetic female who developed EE secondary to a Klebsiella pneumoniae liver abscess. The patient initially presented with fever, fatigue, and abdominal pain, later developing ocular redness and reduced visual acuity. Abdominal ultrasound and computed tomography (CT) confirmed the presence of a multilocular liver abscess. Blood cultures were negative likely due to prior antibiotic use before admission, but Klebsiella pneumoniae was isolated from both the liver abscess and intraocular fluid. She was treated with intravenous (IV) meropenem and metronidazole, along with intravitreal vancomycin and ceftazidime. Despite early percutaneous drainage and antibiotic therapy, the patient's vision did not improve, ultimately requiring evisceration.

Conclusion: This case highlights the importance of early recognition of invasive Klebsiella pneumoniae infections and their metastatic potential. Physicians should consider liver abscess as a possible source of infection in patients presenting with EE. Despite aggressive treatment, the prognosis remains poor, particularly in diabetic patients.