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Ophthalmic Infection Successful Treatment of a Case of Unilateral Endogenous Klebsiella pneumoniae Endophthalmitis Omer Takes, 1 Gamze Kocaoglu, 1 Ziya Ayhan 2 and A Osman Saatci 3 1. Resident; 2. Fellow; 3. Professor, Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey Abstract A 52-year-old woman with diabetes was examined for acute visual loss and ocular pain in oculus dexter (OD). Two weeks earlier, a nephrostomy catheter was inserted for the treatment of nephrolithiasis and 10 days after this procedure she suffered an acute myocardial infarction. During hospitalisation, she developed a high fever and Klebsiella pneumoniae was detected in the blood cultures. On eye examination, mild corneal oedema, minimal hypopyon, vitritis and subretinal abscess of 3DD size at the uppertemporal retina were noted in the right eye. Single intravitreal injection of vancomycin, ceftazidime and clindamycin was given in addition to systemic antibiotic treatment for 14 days. Intraocular inflammation resolved rapidly within days and she regained a visual acuity of 8/10 with a residual chorioretinal scar 2 months later. Endogenous endophthalmitis can be treated successfuly if the diagnosis can be established early enough and treated accordingly. Keywords Endogenous endophthalmitis, intravitreal injection, Klebsiella pneumoniae, retina, uveitis Disclosure: Omer Takes, Gamze Kocaoglu, Ziya Ayhan and A Osman Saatci have no conflicts of interest to declare. No funding was received in the publication of this article. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Compliance with Ethics Guidelines: Informed consent was received from the patient involved in the case study. Received: 11 June 2015 Accepted: 3 July 2015 Citation: European Ophthalmic Review, 2015;9(1):23–4 Correspondence: A Osman Saatci, Mustafa Kemal Pasa Bulvari, No. 73, A blok, Daire: 9, Narlidere, 35320, Izmir, Turkey. E: Endogenous endophthalmitis is a rare inflammatory condition of the intraocular cavity that is caused by the haematogenous spread of bacterial and/or fungal agents from the distant infectious loci mostly located in liver, lung, endocardium, meninges and urinary tract. 1,2 It is commonly associated with an underlying immunosuppressive status including diabetes mellitus, cardiac disease, renal insufficiency and malignancy. Gram-negative bacteriae are relatively more frequent than Gram-positive bacteriae, particularly in Asia. 3 We report a successfully treated case of 52-year-old woman with diabetes who developed Klebsiella pneumoniae septicaemia secondary to nephrostomy and subsequent unilateral endogenous endophthalmitis. Case Report A 52-year-old woman with 20 years history of poorly controlled diabetes experienced acute visual loss and ocular pain in her right eye. Two weeks earlier a nephrostomy catheter was inserted for the treatment of nephrolithiasis. Ten days after this procedure she suffered an acute myocardial infarction and was hospitalised. Three days after the hospitalisation she developed the above-mentioned ocular symptoms in her right eye in association with high fever. She also had herpes labialis for 2 days. On eye examination, best-corrected visual acuity was 1/10 in oculus dexter (OD) and 20/20 in oculus sinister (OS). Slit-lamp examination showed mild corneal oedema, +++ cells, minimal hypopyon and mild to moderate vitritis in OD. The anterior segment was unremarkable in OS. Intraocular pressure was within normal limit oculus uterque (OU). Fundoscopy revealed a subretinal Tou ch MEd ica l MEdia abscess of almost 3DD at the uppertemporal retina in OD and a few cotton-wool spots at the posterior pole in OS (see Figure  1). Blood cultures already demonstrated K. pneumoniae. Our diagnosis was unilateral K.  pneumoniae endophthalmitis (KPEE). She was treated with a single intravitreal injection of vancomycin + ceftazidime and clindamycin in association with the systemic antibiotics (gentamicin + daptomycin and acyclovir) for 14 days. Vitreous culture turned out to be negative. Topical cyclopentolate and prednisolone acetate drops were also administered. Intraocular inflammation resolved rapidly within days and she regained visual acuity of 8/10 with a residual choroiretinal scar 2 months later (see Figure 2). Discussion Among inpatients with haematogenous infection, the overall incidence of presumed endogenous endophthalmitis was 0.04 % among patients with bacteraemia. 4 In a recent review of 342 cases of endogenous bacterial endophthalmitis reported between 1986 and 2012 predisposing conditions were present in 60  % of cases. 2 The median final visual acuity was 20/100 with 44 % of eyes achieving visual acuity worse than 20/200. Among all cases, 24  % required evisceration or enucleation and the mortality was 4  %. The most common causative Gram-negative bacteria were K. pneumonia, Pseudomonas aeruginosa and Neisseria meningitidis and the most common causative Gram- positive bacteria were Staphylococcus aureus, group B Streptococcus, Streptococcus pneumoniae and Nocardia species, respectively. 23