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Case Reports
. 2021 Feb 26;14(2):e239835.
doi: 10.1136/bcr-2020-239835.

Klebsiella pneumoniae liver abscess with endophthalmitis in a diabetic man with gallstones

Michael David  1 , Anna Louise Pouncey  2 , Rajab Kerwat  3 , Sami Habal  4
Affiliations
Case Reports

Klebsiella pneumoniae liver abscess with endophthalmitis in a diabetic man with gallstones

Michael David et al. BMJ Case Rep. .

Abstract

Invasive liver abscess syndrome (ILAS) is caused by Klebsiella pneumoniae and is typically seen in people from East Asia, often with diabetes and gallstones. ILAS includes metastatic sequelae of the infection, commonly to the eyes. The case described below occurred in a London hospital. The patient's abscess was diagnosed on CT and MRI and he developed endophthalmitis secondary to metastatic spread of the infection. He was treated with intravenous and intravitreal antibiotics and discharged with a plan for vitrectomy and cholecystectomy as an outpatient. We discuss the epidemiology, risk factors, pathogenesis, prognosis and management of this rare condition. There have been a number of recent reports of cases of this nature outside of Asia and we believe greater awareness is required. A high index of suspicion should be held for the potential development of metastases in patients of this demographic presenting with abscesses of this nature.

Keywords: general surgery; infection (gastroenterology); infectious diseases; ophthalmology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
A CT abdomen and pelvis in the coronal plane, 2 days after presentation: There is the hypoattenuating-hypoenhanced lesion in the central part of the liver (parahilar region), measuring at least 6.3×5.2 cm, which shows inhomogeneity. There are a few, slightly prominent retroperitoneal lymph nodes but with no significant enlargement.
Figure 2
Figure 2
Funduscopy of the right eye on day 22 postpresentation showing endophthalmitis after initial intravitreal antibiotic injections.
Figure 3
Figure 3
An MRI (T2 weighted, T2W) abdomen and pelvis in the coronal plane, 17 days after presentation: there is a complex multiloculate lesion with restricted diffusion within segments IV and VIII, measuring 7.8x 5.9 cm in diameter. There are calculi within the gallbladder with no biliary dilatation.
Figure 4
Figure 4
Funduscopy of the right eye on day 37 post-presentation showing ongoing endophthalmitis after further intravitreal antibiotic injections.
See this image and copyright information in PMC

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