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Meningoencephalitis due to endogenous endophthalmitis by Klebsiella pneumoniae in a diabetic patient

Rocha-de-Lossada, Carlos; Díaz Antonio, Tania1; Rachwani Anil, Rahul2,; Cuartero Jiménez, Elisa1

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Indian Journal of Ophthalmology: July 2020 - Volume 68 - Issue 7 - p 1456
doi: 10.4103/ijo.IJO_2016_19
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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.

Figure 1:
(a) T1-weighted MRI axial view. High-signal intensity both in the eye and extrinsic orbital musculature on the left side. Poor definition of the optic nerve meningeal sheath (arrow) due to edema. (b) Fat suppression post-gadolinium T1-weighted MRI. Pachymeningeal (green arrowhead) and leptomeningeal enhancement (orange arrowhead). An ependymal enhancement is observed due to ventriculitis (arrow). (c) Contrast-enhanced CT scan. Hypodense fluid collection with rim enhancement involving the left gluteal muscles. (d) Lactose positive colonies of Klebsiella pneumoniae on MacConkey agar

Endogenous endophthalmitis occurs when pathogens disseminated in the blood go through the blood-ocular barrier.[1] Klebsiella pneumoniae is the most frequent pathogen. Metastatic spread to the meninges is rare and could have a devastating outcome.[2]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

1. Shirakawa C, Yanagihara C, Takano S, Ishio Y, Mikawa A. Endogenous endophthalmitis following staphylococcus aureus meningitis Rinsho Shinkeigaku. 2019;59:185–9
2. Ali K, Owen M, Kumar I, Cazabon S. Streptococcus pneumoniae meningitis following postoperative endophthalmitis Eye. 2012;26:1593
© 2020 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow