The Noxious Intruder of the Eye: Endogenous Klebsiella Panophthalmitis

Endogenous Klebsiella pneumoniae panophthalmitis commonly affects those with compromised immunity. The occurrence of this infection in healthy individuals is rare. We describe the case of a healthy adult who presented with endogenous Klebsiella pneumoniae panophthalmitis from an asymptomatic liver abscess. A 64-year-old, previously healthy gentleman presented with rapidly progressive left eye periorbital swelling and blurring of vision. He had a low-grade fever three days prior to the development of ocular symptoms, but otherwise no other systemic complaints. Visual acuity was light perception in the left eye, and ocular motility was restricted in all directions of gaze. Ocular examination revealed proptosis, severe conjunctival chemosis, hazy cornea, and fibrin deposition in the anterior chamber. The posterior segment could not be visualized. Ultrasound of the hepatobiliary system revealed an abscess in the right lobe of his liver. His blood cultures grew Klebsiella pneumoniae. Despite being treated with high-dose intravenous antibiotics, his eye condition deteriorated. Evisceration was performed when he developed scleral melting and globe perforation. We highlight the importance of a high index of suspicion of endogenous Klebsiella panophthalmitis as it can be easily missed in healthy adults. Early diagnosis and prompt management are needed to prevent morbidity and mortality from this devastating infection.