1988 Volume 62 Issue 9 Pages 830-834
Two cases of metastatic K. pneumoniae endophthalmitis spreading from biliary treact infections are reported.
Case 1 A 69-year-old woman with acute fever (39.4°C) and right upper quadrant abdominal discomfort, was admitted. On the 5th hospital, day, she complained of a right orbital pain and acute loss of visuality. Evisceration of the right eyeball contents was performed. Abdominal discomfort continued and a slight elevation of alkaline phosphatase was noted. Cholecystolithiasis and chronic cholecystitis were diagnosed and a cholecystectomy was performed. The culture of both the eyeball contents and the bile yielded K. pneumoniae.
Case 2 A 77-year-old woman with acute fever (39.6°C) and nausea, complained of oribital pain and loss of vision when admitted to the hospital. With the diagnosis of endophthalmitis, the oribtal contents were drained. On admission, it was diagnosed as a cryptogenic liver abscess. The culture of both the eye discharge and liver abscess pus yielded K. pneumoniae.
In the literature, 20 cases of metastatic K. pneumoniae endophthalmitis including our 2 cases are reported. Of the 15 cases biliary tract infection with liver abscess were found in all but 1 case. The prognosis of visual acquity is poor. Sixteen cases became blind and the other 4 cases resulted in severe loss of visual acquity. Because of the poor prognosis, a more aggressive diagnostic and therapeutic approach is required.