Endogenous Klebsiella Endophthahnitis: Report of Two Cases and Review of the Literature

Background: Endogenous endophthalmitis is a rare complication of gram- negative sepsis. The diagnosis often is delayed unless a high index of suspicion exists. Familiarity with the clinical setting in which endogenous Klebsiella endophthalmitis occurs will hasten diagnosis and may improve outcome. Methods: The authors reviewed the medical literature and describe two patients with diabetes who lost vision from endogenous Klebsiella endophthalmitis. Findings: One patient lost all vision in both eyes before the diagnosis of sepsis was clinically suspected. In the other, endophthalmitis was the only clinical sign of septicemia 8 days after hospital discharge for treatment of a Klebsiella urinary tract infection. Survey of the literature showed an increase in the number of cases of endogenous Klebsiella endophthalmitis reported over the last 12 years. Sixty- one percent of the 44 patients reported in the literature since 1981 had diabetes, 68% had suppurative liver disease, and 16% had urinary tract infection. Conclusion: An important implication of these associations is that metastatic Klebsiella endophthalmitis must be considered when vitritis occurs in patients with diabetes, particularly in those with acute liver disease or a urinary tract infection, or in any patient with vitritis and suppurative liver disease.