A 68-Year-Old Type 2 Diabetic Man of Korean Ethnicity With Fever, Abdominal Pain, and Right Eye Visual Disturbance

Diagnosis: K1 hypermucoid Klebsiella pneumoniae metastatic bacteremia with multiple liver abscesses and endophthalmitis. The gram-negative rods in blood cultures identified on day 2 were subsequently identified as a hypermucoid strain of Klebsiella pneumoniae. A presumptive diagnosis of multiple hypermucoid K. pneumoniae liver abscesses with metastatic endophthalmitis was made. Given the clinical presentation of hepatic abscesses (Figure 1) and right eye hypopyon (Figure 3), ethnic background of the patient, and initial colony appearance (Figure 2), a K1 or K2 capsular serotype K. pneumoniae strain was suspected. The patient underwent emergent vitrectomy, and intravitreal ceftazidime was injected. On day 11, repeat funduscopy revealed early changes of left eye endophthalmitis; intravitreal ceftazidime was administered. He eventually defervesced after repeated percutaneous drainage of the larger liver lesions. While his left eye vision remains satisfactory, vision in the right eye did not recover. The K. pneumoniae strain was confirmed as a K1 capsular serotype by the Quellung reaction and multiplex polymerase chain reaction targeting the capsular polysaccharide synthesis (cps) gene cluster. Invasive liver abscess syndrome caused by K1 or K2 capsular serotypes of K. pneumoniae hypermucoid strains can present with bacteremia and extrahepatic metastasis to the lung, eye, Figure 1. Computed tomography scan of abdomen revealing multiple hepatic abscesses. Figure 2. Hypermucoid colonies observed on blood agar following incubation for 24 hours.