[A case of liver abscess associated with endophthalmitis caused by Klebsiella pneumoniae].

A 54-year-old female was admitted to our hospital because of a spiking fever, right hypochondriac pain, right orbital pain and visual disturbance. Before admission she was treated with systemic antibiotics infusion for a diagnosis of liver abscess at the other hospital and the liver abscess almost diminished for a while. With the diagnosis of liver abscess and endophthalmitis, liver drainage and evisceration were carried out. The culture of pus from the eye and liver yielded K. pneumoniae. After liver drainage, evisceration, and direct injection of antibiotics into the eye, inflammatory findings tended to improve. Seven cases of metastatic K. pneumoniae endophthalmitis have been reported so far in Japan. The cases had liver abscess as the primary disease and 3 cases had bilateral endophthalmitis. Five cases with liver abscess survived except one who died of sepsis, but unfortunately, all cases became blind in the affected eyes. The prognosis of bacterial endophthalmitis, especially associated with K. pneumoniae liver abscess, is poor and as the outcome could appear to depend on time when treatment is started, a more aggressive diagnostic approach is required. Moreover systemic antibiotic infusion alone is inadequate for treatment of liver abscess and endophthalmitis, and liver drainage, evisceration and intravitreal injection of antibiotics must be given in early stage.