Favorable Outcome in Recalcitrant Klebsiella pneumoniae Endogenous Endophthalmitis: A Case Report

Endogenous endophthalmitis is an aggressive intraocular infection with a characteristically poor visual prognosis.We present a 55-year-old Malay woman with suboptimally controlled diabetes mellitus who developed sepsis from a liver abscess.Following the isolation of Klebsiella pneumoniae from the abscess drainage, which demonstrated susceptibility to gentamicin and trimethoprim-sulfamethoxazole, she was commenced on targeted systemic antimicrobial therapy.During her admission, she reported a sudden visual decline in her left eye, with visual acuity decreasing to 6/21.Clinical examination of the left eye revealed anterior chamber inflammation with a hypopyon, alongside pronounced vitritis and retinitis, while the right eye remained entirely unaffected.Recognizing this as Klebsiella pneumoniae endogenous endophthalmitis, we immediately performed a vitreous tap and injected intravitreal vancomycin and ceftazidime, proceeding to a trans pars plana vitrectomy (TPPV) with repeat intravitreal antibiotics the following day.Although her vitreous fluid cultures returned negative, the infection resolved on a postoperative regimen of topical 0.5% moxifloxacin, systemic ciprofloxacin, and trimethoprim-sulfamethoxazole, which improved her left eye visual acuity to 6/7.5.Ten weeks later, however, she developed a recurrence of endophthalmitis with a reduction in her vision to 6/18.This was managed promptly with a repeat TPPV, further intravitreal antibiotics, and a silicone oil tamponade.Postoperatively, the patient was started on topical moxifloxacin, along with systemic trimethoprim-sulfamethoxazole and ciprofloxacin.She responded well to this secondary intervention, achieving complete inflammatory resolution and recovering a final pinhole visual acuity of 6/9.This case presents a rare but favorable outcome of Klebsiella pneumoniae endogenous endophthalmitis, which characteristically has a poor prognosis.The prompt, intensive medical and surgical management utilized in this case was a key factor in achieving clinical success.