Panophthalmitis complicated with asymptomatic pyogenic liver abscess caused by Klebsiella pneumoniae: A case report.

RATIONALE

Panophthalmitis is a severe, vision-threatening condition that may result from endogenous spread of infection, often presenting with systemic symptoms. Klebsiella pneumoniae (Kp) is a known cause of endogenous panophthalmitis, typically associated with underlying conditions such as diabetes and often linked to pyogenic liver abscesses. However, cases presenting solely with ocular symptoms are exceedingly rare. This report presents a unique case of Kp panophthalmitis with a concurrent asymptomatic liver abscess, emphasizing the importance of systemic evaluation in atypical ocular infections.

PATIENT CONCERNS

A 66-year-old woman presented with a 3-day history of progressive vision loss, periorbital pain, swelling, and redness in the left eye. She denied fever, gastrointestinal symptoms, or other systemic complaints.

DIAGNOSES

Imaging revealed panophthalmitis with retrobulbar infiltration. Blood tests showed leukocytosis and mildly elevated liver enzymes. A liver abscess was identified on ultrasound and computed tomography. Cultures from the eyelid abscess and liver aspiration both yielded K. pneumoniae.

INTERVENTIONS

The patient received empirical systemic antibiotics, intravitreal injections, and daily wound care. After 2 weeks without visual improvement, evisceration was performed. The liver abscess was aspirated and treated with antibiotics.

OUTCOMES

Despite aggressive treatment, the left eye was nonviable and required evisceration. However, systemic infection was controlled, and the patient remained free of complications from the liver abscess. Notably, she exhibited no systemic symptoms throughout the disease course.

LESSONS

This case highlights the need for systemic evaluation in patients with severe ocular infections, even in the absence of systemic symptoms. It also underscores the potential for serious infections such as Kp-related liver abscess to present solely with ocular manifestations. Early suspicion and comprehensive assessment can prevent misdiagnosis and improve outcomes.