Nosocomial Klebsiella pneumoniae conjunctivitis resulting in infectious keratitis and bilateral corneal perforation.
OBJECTIVE
Klebsiella pneumoniae is a known cause of metastatic endophthalmitis. However, the organism has never been described to cause severe infectious keratoconjunctivitis. We report a fulminant case of nosocomial K. pneumoniae conjunctivitis complicated by infectious keratitis and corneal perforation in both eyes.


METHODS
An 83-year-old previously healthy Chinese woman, blind in the right eye from rubeotic glaucoma and with bilateral dense cataracts, was admitted for observation after a head injury. While in hospital, she developed purulent bilateral conjunctivitis. Repeated cultures grew K. pneumoniae. This rapidly progressed to severe infectious keratitis and corneal perforation in both eyes, despite intensive antibiotics to which the organism was susceptible. The patient was otherwise well, and investigations did not reveal any source of endogenous sepsis.


RESULTS
The patient lost complete vision in both eyes. The left eye turned phthisical, and the right eye was eviscerated for uncontrolled endophthalmitis.


CONCLUSIONS
Although not previously reported, K. pneumoniae can cause devastating keratoconjunctivitis resulting in corneal melt, perforation, and uncontrolled endophthalmitis.
Department of Ophthalmology, Tan Tock Seng Hospital, Singapore.
T
T
Aung
T K
TK
Chan
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D003234:Conjunctivitis, Bacterial / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D003315:Cornea / Q000473:pathology; D065306:Corneal Injuries; D003428:Cross Infection / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D017234:Eye Evisceration; D005260:Female; D006801:Humans; D007634:Keratitis / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D007710:Klebsiella Infections / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D012421:Rupture / Q000382:microbiology
D000900:Anti-Bacterial Agents