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OPHTHALMIC IMAGE
Year : 2020  |  Volume : 68  |  Issue : 7  |  Page : 1456

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


1 Instituto Clinic de Oftalmología, Hospital Clinic de Barcelona, Barcelona, Spain
2 Hospital Universitario Virgen de la Victoria, Radiology Department, Málaga, Spain
3 Hospital Regional Universitario de Málaga Hospital Civil, Ophthalmology Department, Málaga, Spain

Date of Web Publication25-Jun-2020

Correspondence Address:
Dr. Rahul Rachwani Anil
Hospital Regional Universitario de Malaga-Hospital Civil, Ophthalmology Department, Plaza del Hospital Civil s/n. 29009, Malaga
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2016_19

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How to cite this article:
Rocha-de-Lossada C, Díaz Antonio T, Rachwani Anil R, Cuartero Jiménez E. Meningoencephalitis due to endogenous endophthalmitis by Klebsiella pneumoniae in a diabetic patient. Indian J Ophthalmol 2020;68:1456

How to cite this URL:
Rocha-de-Lossada C, Díaz Antonio T, Rachwani Anil R, Cuartero Jiménez E. Meningoencephalitis due to endogenous endophthalmitis by Klebsiella pneumoniae in a diabetic patient. Indian J Ophthalmol [serial online] 2020 [cited 2020 Jul 13];68:1456. Available from: http://www.ijo.in/text.asp?2020/68/7/1456/287546



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 [Figure 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

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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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shirakawa C, Yanagihara C, Takano S, Ishio Y, Mikawa A. Endogenous endophthalmitis following staphylococcus aureus meningitis. Rinsho Shinkeigaku 2019;59:185-9.  Back to cited text no. 1
    
2.
Ali K, Owen M, Kumar I, Cazabon S. Streptococcus pneumoniae meningitis following postoperative endophthalmitis. Eye 2012;26:1593.  Back to cited text no. 2
    


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