Asymmetric presentation of bilateral endogenous endophthalmitis in disseminated Klebsiella pneumoniae infection

Endogenous endophthalmitis is an uncommon complication following haematogenous infection. We describe a man in his early 60s presenting with acute right-sided vision loss and bilateral intraocular inflammation in the context of a systemic febrile illness following recent travel in Southeast Asia. Restorative dental treatment preceded symptom onset, although an odontogenic source was not established. Initial blood cultures prompted treatment for gram-negative septicaemia and investigation for an infective source. Abdominal imaging revealed a pyogenic liver abscess; blood and liver abscess isolates identified Klebsiella pneumoniae, while bacterial 16S rRNA sequencing of a right vitreous biopsy detected Klebsiella species. Despite surgical intervention including intravitreal antibiotics and subsequent phacovitrectomy with drainage of a suprachoroidal collection, the right eye progressed to no perception of light and phthisis, whereas the left subretinal abscess resolved, allowing preservation of useful vision. This case highlights the aggressive nature of disseminated K. pneumoniae infection and the importance of early source identification.