Endogenous Klebsiella endophthalmitis in a Vietnamese immigrant

Citation metadata

Date: Oct. 13, 2009
Publisher: CMA Impact Inc.
Document Type: Case study
Length: 1,749 words
Lexile Measure: 1650L

Document controls

Main content

Article Preview :

A previously healthy 54-year-old carpenter presented with a 13-day history of redness, tearing and pain in his left eye, which was associated with a progressive reduction in visual acuity. He had no fever or other systemic symptoms. He had no history of eye trauma or surgery, and he regularly used eye protection at work. He reported no intravenous drug use. He had immigrated to Canada from Vietnam 14 years before presentation, and his last trip to Vietnam was 7 months before the onset of illness. He initially sought medical attention 1 day after the onset of symptoms, and he was given gentamicin eyedrops for presumed conjunctivitis. After his symptoms did not improve, he was referred to an ophthalmologist.

On examination, his visual acuity was bare light perception in the left eye and 20/40 in the right eye. He had eyelid and conjunctival swelling in the left eye (Figure 1). No hypopyon was seen. Examination with a slit lamp showed corneal edema with 4+ leukocytes (greater than 50 cells visualized) and flare (reflection of light from protein in the aqueous humour) in the anterior chamber. Fibrin was also present in the anterior chamber. The fundus could not be seen. The results of an examination of the patient's right eye were unremarkable. The patient did not have a fever, and the rest of a physical examination, including an abdominal exam, was unremarkable. A presumptive diagnosis of left endogenous endophthalmitis was made. A tap of the vitreous and anterior chamber of the patient's left eye was performed, and 1.0 mg vancomycin and 2.25 mg ceftazidime were administered into the vitreous.

Within 48 hours, Klebsiella pneumoniae grew in a culture from the vitreous. The patient was admitted to hospital, and infectious disease specialists were consulted. By this time, the patient had increasing eye pain and lid swelling. The results of a physical examination were otherwise unchanged. Laboratory data obtained on admission were within normal ranges, except for a leukocyte count of 15.5 (normal 4-11) X [10.sup.9]/L with 92% neutrophils. Liver function tests were not performed. Blood and urine cultures were negative. A computed tomography (CT) scan of the orbit of his left eye (Figure 2) showed periorbital swelling with marked proptosis.

Given the potential association of K. pneumoniae liver abscess and K. pneumoniae endophthalmitis, a CT scan of the patient's abdomen was performed, which showed a complex 4.7 X 2.7 cm hypodense mass with multiple septations in the right lobe of his liver (Figure 3). Ultrasound-guided percutaneous drainage of the mass was performed, and culture of the fluid yielded K. pneumoniae.

The K. pneumoniae isolates were sensitive to all antimicrobials tested,...

Source Citation

Source Citation   

Gale Document Number: GALE|A210520603