Endogenous endophthalmitis by hypervirulent Klebsiella pneumoniae: a case report and literature review

Abstract

Endogenous endophthalmitis is a rare intraocular infection with a poor prognosis, caused by the hematogenous spread of microorganisms, notably hypervirulent Klebsiella pneumoniae (hvKp), an emerging pathogen associated with severe metastatic infections.

The case is presented of a 65-year-old man of Chinese descent, previously healthy, who presented with fever, ocular hyperemia, and reduced visual acuity in one eye. The diagnosis of K. pneumoniae endophthalmitis was confirmed by vitreous fluid cultures and blood cultures, which identified a hypermucoviscous phenotype consistent with hvKp. Despite systemic and intravitreal antibacterial treatment, the clinical course was poor, necessitating enucleation. The patient then developed pulmonary and neurological complications, with imaging findings suggesting spread to the central nervous system, and he responded favorably to ceftriaxone. This case highlights the aggressiveness of hvKp-induced endophthalmitis and the importance of early diagnosis in optimizing treatment and improving visual prognosis.