A retrospective study of endogenous endophthalmitis-related pyogenic liver abscess: An increasing complication in North Vietnam

Abstract

Introduction: Endogenous endophthalmitis-related Klebsiella pyogenic liver abscess is a rare complication of metastatic infection. In most cases, visual acuity results are often impaired, even blind, and even with aggressive treatment with topical antibiotics, the final results are unsatisfactory. The objective of this study is to retrospectively based on medical records to describe clinical features, risk factors, and visual outcomes of patients with endogenous endophthalmitis-related pyogenic liver abscesses.

Methods: We reported a case series of 12 endogenous endophthalmitis-related pyogenic liver abscess patients from March 2021 to 2023. All cases of endogenous endophthalmitis were diagnosed at admission or during the hospital stay.

Results: From the medical records of 588 pyogenic liver abscess patients, we found 12 cases of endogenous endophthalmitis with 2.0%. The result showed a mean age of 61.5 ± 12.0 (41-78), diabetes mellitus (7 of 12), right lobe (7 of 12), single abscess (9 of 12), and the mean largest abscess diameter of 5.8 ± 1.7 cm (3.3-9). All patients had ocular symptoms such as eye pain (9 of 12), pus discharge (3 of 12), hypopyon (1 of 12), swollen eyelids (2 of 12), and corneal edema (2 of 12), pyogenic liver abscess before endogenous endophthalmitis (10 of 12), the median interval between endogenous endophthalmitis and pyogenic liver abscess 6.1 ± 1.9 days, ocular symptoms before diagnosis endogenous endophthalmitis 4.4 ± 2.3 days. All affected eyes were injected intravitreously with ceftazidime, amikacin, and vancomycin. Two patients underwent evisceration.

Conclusions: Endogenous endophthalmitis has permanent morbidity, reducing visual acuity, poor quality of life, and lacks the warning signs, so it is essential for early detection of symptoms and referral to ophthalmologists.

Keywords: Klebsiella pneumoniae; Pyogenic liver abscess; endophthalmitis.

Figure 1.

Eye involvement and pyogenic liver abscess of patient one. (a) OS involvement. (b) Contrast-enhanced abdominal computerized tomography (CT) scanning showed hepatomegaly with 19.5 cm. The posterior parenchymal segment adjacent to the diaphragm has heterogeneous hypoechoic foci of size 70 × 55 × 50 mm, cortical enhancement, central liquefaction, and perfusion disturbances in the liver parenchyma around the lesion. (c and d) On magnetic resonance imaging, there is a component of increased signal on T1W, decreased T2W, limited diffusion, and no enhancement after injection. Infiltrate the orbital soft tissue around the eyeball and the lateral rectus muscle on OS, enhancing after injection.