Invasive Endophthalmitis in a Diabetes Patients Associated with Pyogenic Liver Abscesses.

Background/Aims Klebsiella pneumoniae is the major cause of endophthalmitis associated with liver abscess, accounting for up to 60% of cases. Acute bacterial endophthalmitis is a vision-threatening condition and must be managed as an emergency. Methods The clinical complained of decreased vision and pain, eyelid edema, photophobia, and the presence of floaters. By characteristic ocular findings on detailed ophthalmoscopic examination in the setting of positive blood cultures or by positive vitreous or aqueous cultures difficult. Multiple clinic visits may be required to confirm the diagnosis. Results This 65-year-old male had past history of type 2 diabetes, hypertension, chronic kidney disease. This time, suffered from intermittent fever with chill for 4 to 5 days, drowsiness consciousness, and general weakness for 1 day, also with epigastric pain and poor intake. The laboratory data showed hyperglycemia, elevated blood osmolality, ketone body and C-reactive protein. The abdomen computed tomography revealed Liver abscess at lateral segment (about 4x2.6 cm) and probably small hepatic abscess or cyst at S7. However, sinus tachycardia with dyspnea were developed, emergency intubation was performed and transfer to intensive care unit. Initially strong antibiotic with meropenem and consult OPH to exclude endophthalmitis and the diagnosis with Senile cataract, nonproliferative diabetic retinopathy and chronic conjunctivitis. K. pneumonia bacteremia was noted later and we had kept antibiotic use. However, the patient had complained vision loss and consult OPH again for exclude endophthalmitis and bilateral retinal detachment and vitreous opacity was found. Orbital magnetic resonance imaging (MRI) was performed and revealed left intraocular linear diffusion restriction and increased bilateral scleral enhancement, in favor of endophthalmitis. OPH arrange intravitreal injection of antibiotic. After treatment, his condition was got improving and transfer to ward later but still vision loss oculus uterque. Conclusions In Taiwan, and other East Asian nations K. pneumoniae is the major cause of endophthalmitis associated with liver abscess, accounting for up to 60% of cases. Including decreased vision (the most common reason for visiting doctor) and pain, eyelid edema and the presence of floaters. Determined by the need to treat the underlying source of bacteremia. All patients also require IV of antibiotic, vitrectomy debrides the vitreous and leads to better visual outcome in severe cases of endophthalmitis. Span >OPH to exclude endophthalmitis and the diagnosis with senile cataract, nonproliferative diabetic retinopathy and chronic conjunctivitis. K. pneumonia bacteremia was noted later and we had kept antibiotic use. However, the patient had complained vision loss and consult OPH again for exclude endophthalmitis and bilateral retinal detachment and vitreous opacity was found. Orbital MRI was performed and revealed left intraocular linear diffusion restriction and increased bilateral scleral enhancement, in favor of endophthalmitis. OPH arrange intravitreal injection of antibiotic. After treatment, his condition was got improving and transfer to ward later but still vision loss oculus uterque. [ABSTRACT FROM AUTHOR]