Fulminant Klebsiella pneumoniae Endogenous Endophthalmitis With Globe Perforation and Disseminated Infection: A Case Report.

Endogenous endophthalmitis (EE) occurs when microorganisms spread hematogenously to the eye, resulting in intraocular infection. While Gram-positive organisms are the most common causes in the United States, hypervirulent Klebsiella pneumoniae has emerged as an increasingly recognized pathogen associated with liver abscess and metastatic infection. We report the case of a 51-year-old woman with previously undiagnosed diabetes who presented with progressive vision loss in the right eye and systemic symptoms after recent travel to China. Ophthalmic examination demonstrated hypopyon and severe intraocular inflammation consistent with endogenous endophthalmitis. Blood and vitreous cultures grew Klebsiella pneumoniae. Despite prompt treatment with intravitreal and systemic antibiotics, the patient developed extensive disseminated infection, including multifocal pneumonia, cerebral septic emboli, and a large multiloculated liver abscess with hepatic venous thrombosis requiring drainage. The affected eye rapidly progressed to no light perception with development of a scleral abscess and spontaneous globe perforation, ultimately necessitating enucleation. This case highlights the aggressive metastatic potential of hypervirulent K. pneumoniae infection and underscores the importance of early recognition, systemic evaluation for occult abscesses, and coordinated multidisciplinary management. Increasing reports of Klebsiella endogenous endophthalmitis in the United States suggest expanding global dissemination of this pathogen.