Discussion
As we know from the basics of microbiology, Klebsiella pneumoniae is
a gram-negative, facultative anaerobic, rod-shaped bacterium belonging
to the Enterobacteriaceae genus. K. pneumoniae infections are
usually hospital-acquired and occur in patients with impaired immunity.
A unique exception to this is syndromes involving community-acquired
primary liver abscesses which have been typically described in East Asian
countries.1 We present a case of panophthalmitis and
cerebellar abscess in association with a pyogenic liver abscess caused
due to K. pneumoniae. Panophthalmitis differs from
endophthalmitis due to inflammation extending to periocular tissue
thereby involving all structures of the eyeball. A study on endogenous
panophthalmitis described that 12 out of 18 patients with
panophthalmitis had an infection caused by K. Pneumoniae, which
was most commonly associated with liver abscesses.2Our case adds to the list with an addition that the central nervous system
(CNS) complications can occur concurrently along with panophthalmitis.
A Taiwanese retrospective cohort study of 177 cases of K.
pneumoniae pyogenic liver abscess identified genotype K1 as a possible
significant risk factor for causing ocular and CNS
complications.1 Although the K1 serotype may be an
important risk factor, the K2 serotype might also carry the potential of
invasive disease.3 Cases of K2 serotype causing
invasive liver abscess have been reported and it is certainly possible
to develop metastatic infections in such instances.4,5 Diabetes is a notable risk factor for metastatic
infectious disease as evident in our case.6,7 Genotype identification of Klebsiella was not done
in this particular case, which is one of the limitations in this report.
A 20-year retrospective study regarding K. pneumoniae endophthalmitis in association with pyogenic liver abscess concluded
that only 5 patients out of 144 had more than one infectious focus;
making it extremely rare.8 The same study also
concluded that pyogenic liver abscess-related endophthalmitis due to K. pneumoniae leads to poor visual outcomes.8The right lobe of the liver is the most common site of abscess formation
possibly due to typical unequal portal venous distribution from superior
and inferior mesenteric vein.9
Management involves early initiation of intravenous antibiotics along
with surgical or percutaneous drainage of the liver abscess to reduce
morbidity and mortality. Prognosis in terms of visual outcome ofK. Pneumoniae endophthalmitis is generally poor; prompt treatment
is necessary. The patient may require evisceration or enucleation, but
early vitrectomy may be useful in a select group of patients who do not
respond to intravitreal antibiotics.7