NECROTIZING PANOPHTHALMITIS FROM ASYMPTOMATIC LIVER ABSCESS IN A FILIPINO MALE
GC Carpio, M.D.1 J Uy, M.D.2 A Go, M.D.1 AE Ismael, M.D.1 1Section of Gastroenterology, Department of Medicine, University of Santo Tomas Hospital 2Department of Ophthalmology, University of Santo Tomas Hospital
Significance: Klebsiella pneumoniae is emerging as the microbiologic agent that causes hepatic abscess-related metastatic endophthalmitis in immunocompromised patients including diabetics. The aim of this study is to discuss a case of metastatic panophthalmitis from an asymptomatic liver abscess.
Clinical Presentation: This is a case of a 59-year-old, male, with poorly controlled diabetes mellitus, who presented with rapidly progressive unilateral visual loss, ocular pain, chemosis, external ophthalmoplegia, and proptosis of left eye.
Management: B-scan sonography showed choroidal thickening, multiple hyperechoic vitreous opacities, and positive T-sign suggestive of panophthalmitis. Orbital CT scan revealed abnormal thickening of the globe, and orbital cellulitis. Initial bacterial culture of eye discharge was negative hence, impression of possible mucormycosis was entertained. Systemic work-up showed incidental finding of elevated liver enzymes prompting abdominal ultrasound revealing a large liver abscess. Despite intensive antimicrobial therapy, the globe progressively proptosed, and corneal melt ensued with resulting rupture leading to exenteration. Liver abscess drainage culture was positive for K. pneumoniae similar to culture result of the eye discharge from ruptured globe.
Conclusion: K. pneumoniae is an aggressive causative agent of pyogenic liver abscess-related metastatic endophthalmitis in Southeast Asia. Population at risk are those with uncontrolled diabetes mellitus. An alarming increase of documented cases in this region confers high index of suspicion for timely diagnosis and management because it creates a tumultuous ward course that can progress to debilitating panophthalmitis which can cause permanent loss of vision or even disfigurement. This case emphasizes the importance of early diagnosis and treatment of metastatic eye infection from liver abscess.
Keywords: Case report, metastatic panophthalmitis, liver abscess, K. pneumoniae