Introduction: Endogenous endophthalmitis is a rare but vision-threatening intraocular infection resulting from hematogenous spread of infection from a distant site. Klebsiella pneumoniae is an uncommon but increasingly recognized cause, most often associated with pyogenic liver abscesses. We present a rare case of K. pneumoniae endogenous endophthalmitis originating from a genitourinary abscess.
Description: A 52-year-old male with a medical history of type 2 diabetes mellitus, hypertension, and prior cerebrovascular accident presented with abdominal pain and was found to have both prostatic and renal abscesses. The prostatic abscess was drained, and both blood and wound cultures grew K. pneumoniae. His hospital course was complicated by an acute change in mental status, prompting brain imaging that revealed findings most consistent with ventriculitis versus meningitis, as well as a new left posterior cerebral artery (PCA) stroke. Given the presence of bacteremia with metastatic involvement of non-contiguous sites, the infection was classified as disseminated K. pneumoniae, raising strong suspicion for a hypermucoviscious strain. This prompted an ophthalmology consult to evaluate for endogenous endophthalmitis. Fundoscopic findings were concerning for the diagnosis, and intravitreal antibiotics were administered alongside systemic therapy with intravenous ceftriaxone for 5 weeks.
Discussion: K. pneumoniae is a rare cause of endogenous endophthalmitis in Western populations, typically affecting immunocompromised individuals, particularly those with diabetes. This case illustrates an uncommon presentation of K. pneumoniae bacteremia leading to endogenous endophthalmitis originating from a genitourinary abscess. Hypervirulent strains - often of K1 or K2 capsular serotypes - exhibit a hypermucoviscous phenotype and enhanced metastatic potential. These are more prevalent in East Asia, though increasingly reported globally. The presence of diabetes and Klebsiella bacteremia should prompt the clinician to consider the possibility of the hypermucoviscous strain that has a high risk of systemic and ocular dissemination. Given the potential for irreversible complications, prompt recognition, early microbiological identification, and aggressive systemic and intraocular treatment are essential.
