White-Eye Presentation of Endogenous Klebsiella pneumoniae Endophthalmitis with a Choroidal Abscess Secondary to Colorectal Sepsis: A Case Report

Abstract Purpose: Endogenous endophthalmitis is sight-threatening and commonly produces marked ocular inflammation. Klebsiella pneumoniae endogenous endophthalmitis is classically associated with pyogenic liver abscess, whereas colorectal sources and externally quiet presentations are rarely reported. We describe culture-positive multidrug-resistant K. pneumoniae endogenous endophthalmitis with a clinically diagnosed choroidal abscess secondary to colorectal sepsis. Method: Brief report. Results: A 58-year-old man with stage IV rectal adenocarcinoma, tumour perforation and a K. pneumoniae -positive retroperitoneal abscess presented with painless visual deterioration in the left eye. Visual acuity was 6/9 in the right eye and hand movements in the left. Examination of the right eye was otherwise normal. The left eye appeared externally white, without conjunctival injection or lid swelling, despite hypopyon, fibrin and dense vitritis. B-scan ultrasonography showed vitreous loculations, an 11.07-mm dome-shaped choroidal elevation and exudative retinal detachment. K. pneumoniae was isolated from the retroperitoneal abscess, blood and vitreous, supporting haematogenous dissemination. He received four intravitreal injections of vancomycin and ceftazidime with intravenous ceftriaxone. Repeat ultrasonography after two weeks showed persistent vitreous loculations but resolution of the choroidal elevation and a flat retina. Vision deteriorated to no perception of light, systemic instability precluded vitrectomy, and the patient died approximately five weeks later. Conclusion: An externally quiet white eye can conceal severe K. pneumoniae endogenous endophthalmitis. Acute visual deterioration in a septic or immunocompromised patient warrants urgent posterior-segment assessment, vitreous sampling, intravitreal antimicrobial therapy and systemic source control. Visual prognosis remains guarded despite prompt ocular and systemic antimicrobial treatment.