Chuang Shu-Han, Chang Cheng-Hsien
Division of General Practice, Department of Medical Education, Changhua Christian Hospital, Changhua, Taiwan.
Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan.
Medicine (Baltimore). 2025 Jun 6;104(23):e42825. doi: 10.1097/MD.0000000000042825.
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.
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.
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.
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.
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.
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.
全眼球炎是一种严重的、威胁视力的疾病，可能由感染的内源性传播引起，常伴有全身症状。肺炎克雷伯菌（Kp）是内源性全眼球炎的已知病因，通常与糖尿病等基础疾病有关，且常与化脓性肝脓肿相关。然而，仅表现为眼部症状的病例极为罕见。本报告介绍了一例独特的Kp全眼球炎合并无症状肝脓肿的病例，强调了在非典型眼部感染中进行全身评估的重要性。
一名66岁女性，左眼渐进性视力丧失、眶周疼痛、肿胀和发红3天。她否认发热、胃肠道症状或其他全身不适。
影像学检查显示全眼球炎伴球后浸润。血液检查显示白细胞增多和肝酶轻度升高。超声和计算机断层扫描发现肝脓肿。眼睑脓肿和肝脏穿刺培养均培养出肺炎克雷伯菌。
患者接受经验性全身抗生素治疗、玻璃体内注射和每日伤口护理。2周后视力无改善，遂行眼球摘除术。肝脓肿进行了穿刺并使用抗生素治疗。
尽管进行了积极治疗，左眼仍无法保留，需要进行眼球摘除术。然而，全身感染得到控制，患者未出现肝脓肿并发症。值得注意的是，在整个病程中她没有表现出全身症状。
本病例强调了即使在没有全身症状的情况下，对严重眼部感染患者进行全身评估的必要性。它还强调了像Kp相关肝脓肿这样的严重感染仅表现为眼部症状的可能性。早期怀疑和全面评估可以防止误诊并改善治疗结果。
