Meningoencephalitis due to endogenous endophthalmitis by Klebsiella pneumoniae in a diabetic patient
A 72-year-old woman presented with left eye pain, no light perception, and ocular movement restriction. Brain-MRI showed an enlarged left eyeball with abnormal intensity, and extraocular and meningeal extension along the optic nerve sheath spreading into the brain causing meningoencephalitis with ventriculitis [Fig. 1]. Thoraco-abdominopelvic CT revealed a gluteal abscess as a potential embolic focus. Vitreous and gluteus exudates cultures found Klebsiella pneumoniae. The patient improved after enucleation.
Endogenous endophthalmitis occurs when pathogens disseminated in the blood go through the blood-ocular barrier. Klebsiella pneumoniae is the most frequent pathogen. Metastatic spread to the meninges is rare and could have a devastating outcome.
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