Invasive Klebsiella Syndrome with Liver Abscess and Endogenous Endophthalmitis

Thang Dinh Nguyen,1 Huong Tu Lam,2 Thong Duy Vo2,3 1Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam; 2Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; 3Department of Gastroenterology, University Medical Center Ho Chi Minh City, Ho Chi Minh city, VietnamCorrespondence: Thong Duy Vo, Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, University Medical Center Ho Chi Minh City, 217 Hong Bang, Ward 11, Dis. 5, Ho Chi Minh City, 71724, Vietnam, Tel +84 932039888, Email [email protected]; [email protected]: Invasive Klebsiella syndrome is an emerging infectious condition that frequently involves pyogenic liver abscess (PLA) and metastatic complications such as endogenous endophthalmitis (EE). This condition is often associated with diabetes mellitus and can result in poor visual prognosis despite treatment.Case Description: We present the case of a 53-year-old diabetic female who developed EE secondary to a Klebsiella pneumoniae liver abscess. The patient initially presented with fever, fatigue, and abdominal pain, later developing ocular redness and reduced visual acuity. Abdominal ultrasound and computed tomography (CT) confirmed the presence of a multilocular liver abscess. Blood cultures were negative likely due to prior antibiotic use before admission, but Klebsiella pneumoniae was isolated from both the liver abscess and intraocular fluid. She was treated with intravenous (IV) meropenem and metronidazole, along with intravitreal vancomycin and ceftazidime. Despite early percutaneous drainage and antibiotic therapy, the patient’s vision did not improve, ultimately requiring evisceration.Conclusion: This case highlights the importance of early recognition of invasive Klebsiella pneumoniae infections and their metastatic potential. Physicians should consider liver abscess as a possible source of infection in patients presenting with EE. Despite aggressive treatment, the prognosis remains poor, particularly in diabetic patients.Keywords: liver abscess, Klebsiella pneumoniae, endogenous endophthalmitis