title: More Than Meets the Eye: Klebsiella pneumoniae Invasive Liver Abscess Syndrome Presenting with Endophthalmitis.
abstract: BACKGROUND
  Endophthalmitis is a feared complication of pyogenic liver abscesses caused by hypervirulent Klebsiella pneumoniae strains. First described in East Asia in the 1980s, this invasive syndrome is only recently emerging in Europe and America.
  
  
  METHODS
  We describe an 84-year-old man who presented to the emergency department with fever, orbital cellulitis, and bilateral visual loss. Although the patient had no overt abdominal symptoms, computed tomography scan revealed a pyogenic liver abscess. Blood cultures were positive for K. pneumoniae. Initial treatment consisted of intravenous ceftriaxone and intravitreal ceftazidime. A unilateral vitrectomy was performed. The patient survived with severe visual sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: K. pneumoniae pyogenic liver abscess with metastatic endophthalmitis is a relatively new syndrome that should be considered in patients presenting with acute vision loss who appear septic, with or without abdominal complaints. Early recognition prohibits delays in lifesaving treatment.
authors.affiliation: Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Van Keer
authors.affiliation: Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Karel
authors.initials: K
authors.lastname: Van Keer
authors.affiliation: Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Joachim
authors.initials: J
authors.lastname: Van Calster
authors.affiliation: Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Inge
authors.initials: I
authors.lastname: Derdelinckx
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002443:Ceftriaxone / Q000494:pharmacology / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000458:organization & administration; D009877:Endophthalmitis / Q000175:diagnosis*; D005334:Fever / Q000209:etiology; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications* / Q000503:physiopathology; D007711:Klebsiella pneumoniae / Q000472:pathogenicity; D046290:Liver Abscess, Pyogenic / Q000150:complications*; D008297:Male; D014786:Vision Disorders / Q000209:etiology / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone
keywords: Klebsiella pneumoniae; endophthalmitis; invasive liver abscess syndrome; liver abscess