AUTHORS:
Edward H. Wood, MD,1 Matthew A. Powers, MD, MBA,1 Suzann Pershing, MD,1,2 Darius M. Moshfeghi, MD1
TITLE:
Spontaneous globe rupture due to rapidly evolving endogenous hypermucoid klebsiella pneumoniae endophthalmitis
PURPOSE:
To describe a rare case of spontaneous globe rupture from Klebsiella Pneumoniae endophthalmitis and provide a literature review
METHODS:
Retrospective Case Report and Literature Review
RESULTS:
A middle-aged man with poorly controlled type 2 diabetes mellitus presented with 5 days of progressively blurred vision with floaters and pain in the right eye. He had been admitted at a community hospital receiving intravenous antibiotics for klebsiella pneumonia with severe sepsis and respiratory failure, and was thought to have a clear cornea. His blurry vision and eye pain gradually worsened until he heard a “pop,” after which he felt a relief of pressure and the sensation of liquid on his upper cheek (Figure 1). At this point he was transferred to our hospital for formal ophthalmologic evaluation, where he was found to have spontaneous globe rupture from endogenous hypermucoid klebsiellaendophthalmitis. His vision was no light perception, and there was copious purulent material extruding from the anterior chamber admixed with vitreous and lens material through a necrotic cornea (Figure 2). The fellow eye was uninvolved. He received a primary enucleation in the right eye, and eventually systemically recovered from his infection.
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CONCLUSIONS:
There have been only four previously reported cases of spontaneous globe rupture from endophthalmitis.1-4 Out of the now five reported cases, all have been due to endogenous endophthalmitis, four have been due to gram negative bacteria, and three due to klebsiella pneumoniae. K. pneumoniae, especially the hypermucoid variant with a protective polysaccharide capsule, is an emerging pathogen with remarkable virulence.
Figure 1: External Photograph of both eyes.
Figure 2: External Photograph of the right eye, showing a shrunken and markedly inflamed globe with copious purulent material admixed with lens material emerging through a necrotic cornea
Author Affiliations:
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1Byers Eye Institute, Dept. of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA
2VA Palo Alto Health Care System, Palo Alto, CA
Funding/Support:
We have not received any government and non-government support (e.g. commercial companies, foundations, etc.).
Financial Disclosures:
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Edward H. Wood, MD, Matthew A. Powers, MD, MBA have no financial disclosures.
Dr. Pershing has the following financial disclosures
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Acumen, LLC: Consultant
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Digisight Technologies: Consultant; Equity
Dr. Moshfeghi has no relevant disclosures to this poster, but does have the following financial disclosures in general
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Alcon Laboratories, INC: Consultant/Advisor
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Genentech, INC: Consultant/Advisor
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Grand Legend Technology, LTD: Consultant/Advisor, Equity
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Iconic Therapeutics, INC: Consultant/Advisor, Steering Committee
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Insitu Therapeutics, INC: Consultant/Advisor, Equity, Patents
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Krypton Vision, INC: Consultant
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Promisight, INC: Founder, Equity, Director
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Versl, INC: Founder, Equity, Director
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Visunex Medical Systems, CO, LTD: Consultant/Advisor, Equity
References
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Erkalp K, Gokhan Teker M, Ozdemir H, Taskapili M, Selim Kocabora M. Endogeneous endophthalmitis by Klebsiella pneumoniae complicated with corneal perforation in Intensive Care Unit. Minerva Anestesiol. 2013;79(2):210-211.
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Michelson PE, Rupp R, Efthimiadis B. Endogenous Candida Endophthalmitis Leading to Bilateral Corneal Perforation. American journal of ophthalmology; 1975.
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Tae KS, Kim TH, Moon YS, Chin HS. A Case of Klebsiella Endogenous Endophthalmitis Accompanied by Necrotizing Scleral Perforation. J Korean Ophthalmol Soc. 2003;44(11):2680-2686.
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Wasserman BN, Sondhi N, Carr BL. Pseudomonas-Induced Bilateral Endophthalmitis with Corneal Perforation in a Neonate. Journal of American Association for …; 1999.