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Klebsiella pneumoniae liver abscess complicated by endogenous endophthalmitis: the importance of early diagnosis and intervention

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Clinical record

A 51-year-old man presented to the Royal Victorian Eye and Ear Hospital with 3 days of progressive visual loss and pain in the left eye, and a 6-hour history of painless visual loss in the right eye. He reported a 1-week history of fever, night sweats, sore throat and a non-productive cough. The man was systemically well, with no features of sepsis or abdominal pain.

His only medical history was for hypercholesterolaemia. He was Malaysian, but had lived in Australia for 10 years. He had recently travelled to Malaysia and Vietnam.

Visual acuity (VA) was hand movements in the left eye and 6/12 in the right. He had a left relative afferent pupillary defect and bilateral hypopyon. Vitritis limited posterior segment examination. The left eye had lid swelling, conjunctival chemosis, proptosis, and computed tomography (CT) showed evidence of scleritis (Figure, A).

White cell count (26 × 109/L; reference interval [RI], 4.0–11.0 × 109/L) and C-reactive protein levels (199 mg/L; RI <5 mg/L) were both elevated; liver function tests were deranged, with evidence of cholestasis. Liver ultrasonography revealed a 5.3 cm abscess in segment VII. A CT scan showed two abscesses: a 5.0 × 5.7 cm abscess in segments V/VIII and a 3.3 × 5.1 cm abscess in segment VII, with cholelithiasis…