A Case of Renal Abscess associated with endogeneous endophthalmitis and septic pulmonary embolism byKlebsiella pneumoniae

Abstract

Klebsiella pneumoniae is a pathogen that causes a wide range of infections in the human body and has a tendency to metastasize to multiple organs. Endogenous Klebsiella endophthalmitis is an infrequent but often devastating septic metastatic infection. It tends to be fulminant and often rapidly progresses to permanent visual loss beyond 24 hours after symptom onset, despite therapy with appropriate antibiotics, particularly with a delay in diagnosis and treatment. While endogenous Klebsiella endophthalmitis has mostly been reported in association with primary liver abscesses, it has rarely been reported with other Klebsiella infections including renal abscesses. Here, we present a case of a 73-year-old diabetic female diagnosed with a Klebsiella renal abscess and endogenous endophthalmitis, after developing left flank pain and bilateral decreased visual acuity. She was treated with systemic antibiotics, percutaneous abscess drainage, an intravitreal antibiotics injection, and a vitrectomy. While the renal abscess slowly resolved, the symptoms of endophthalmitis persisted despite treatment. This report suggests that endogenous endophthalmitis should be considered when diabetic patients with renal abscesses complain of ocular symptoms.

A Case of Ventriculitis Associated with Renal Abscess Caused by Serotype K1Klebsiella pneumoniae

“…In Korea, there have been a few reports of disseminated infection due to K. pneumoniae . Jung et al [ 9 ] reported a case of endogenous endophthalmitis and septic pulmonary embolism in K. pneumoniae renal abscess, and this report also have summarized cases of K. pneumoniae infection with multiple foci, involving endoophthlmitis, renal, liver or prostate infection and CNS infection with concomitant liver abscess or spondylitis. However, no cases of metastatic CNS infection with K. pneumoniae renal abscess have been reported.…”

Endogenous endophthalmitis secondary to perirenal abscess

“…infections, reported mainly in association with liver abscesses, and less frequently to perirenal abscesses. 3,4 Case presentation This is a 61-year-old woman with a history of poorly controlled non-insulin-requiring diabetes mellitus 2 who consulted the emergency department of the Regional Hospital of Rancagua due to red eye, pain and decreased vision in the right eye, for which ophthalmology evaluation was requested. At the anamnesis, the patient reported 3 weeks of evolution, characterized by bilateral lumbar pain and fever, for which she was diagnosed with AP and treated in another hospital with trimethoprim/sulfamethoxazole for 10 days with partial clinical response.…”

“…Diabetes is a known risk factor for Klebsiella spp. infections, reported mainly in association with liver abscesses, and less frequently to perirenal abscesses 3,4 …”

“…infections, reported mainly in association with liver abscesses, and less frequently to perirenal abscesses. 3 , 4 …”