Endogenous endophthalmitis caused by Klebsiella pneumoniae secondary to prostatic abscess: a report of two cases.

Endogenous endophthalmitis is a rare but severe intraocular infection caused by hematogenous spread from distant infectious foci and is often associated with poor visual outcomes. Klebsiella pneumoniae is an important pathogen responsible for invasive infections with bacteremia and metastatic complications. Although liver abscess is a well-known source of K. pneumoniae bacteremia leading to endogenous endophthalmitis, prostatic abscess as the primary focus has rarely been reported. We report two cases of endogenous endophthalmitis associated with prostatic abscess caused by K. pneumoniae. The first patient was a 37-year-old man who presented with fever and lower urinary tract symptoms followed by acute visual loss. Blood and urine cultures grew K. pneumoniae. Imaging revealed a prostatic abscess and septic pulmonary embolism. The abscess resolved with systemic antibiotics without drainage, but severe visual impairment persisted. The second patient was a 68-year-old man with benign prostatic hyperplasia who developed fever and visual disturbance. Blood cultures were negative, but K. pneumoniae was isolated from urine, and CT showed a prostatic abscess with liver abscess. Despite treatment, ocular inflammation progressed with elevated intraocular pressure and severe pain, requiring enucleation. These cases highlight that prostatic abscess can be a source of invasive K. pneumoniae infection with metastatic spread including endogenous endophthalmitis. Early recognition and treatment are essential to prevent severe complications and irreversible visual loss.