Klebsiella pneumoniae cryptogenic liver abscess and endophthalmitis – a case report and review of literature

Klebsiella pneumoniae has emerged as the predominant pathogenic agent of liver abscess in Asia, and the incidence is increasing worldwide. Hypervirulent strains are associated with septic metastatic dissemination in the eyes, lungs, and central nervous system, causing severe morbidity. We present the case of a 54year old man, with no previous comorbidities, admitted in emergency for the blind red painful eye. Further investigation documented septic endophthalmitis with transscleral extension and orbital cellulitis. Thoraco-abdominal computed tomography evidenced a hepatic abscess as the locus of the primary infection. Intravenous antibiotherapy with cefuroxime, followed by meropenem and vancomycin were efficient for managing the hepatic abscess. However, as the eyeball was perforated at the admission, evisceration was performed. The vitreous sample revealed Klebsiella pneumoniae, with a positive string test as the etiologic agent. The diagnostic and therapeutic management required a permanent collaboration between an ophthalmologist, infectious diseases specialist, surgeon, and radiologist

Klebsiella pneumoniae cryptogenic liver abscess and endophthalmitis – a case report and review of literature

Klebsiella pneumoniae has emerged as the predominant pathogenic agent of liver abscess in Asia, and the incidence is increasing worldwide. Hypervirulent strains are associated with septic metastatic dissemination in the eyes, lungs, and central nervous system, causing severe morbidity. We present the case of a 54year old man, with no previous comorbidities, admitted in emergency for the blind red painful eye. Further investigation documented septic endophthalmitis with transscleral extension and orbital cellulitis. Thoraco-abdominal computed tomography evidenced a hepatic abscess as the locus of the primary infection. Intravenous antibiotherapy with cefuroxime, followed by meropenem and vancomycin were efficient for managing the hepatic abscess. However, as the eyeball was perforated at the admission, evisceration was performed. The vitreous sample revealed Klebsiella pneumoniae, with a positive string test as the etiologic agent. The diagnostic and therapeutic management required a permanent collaboration between an ophthalmologist, infectious diseases specialist, surgeon, and radiologist.</jats:p

Graves’ ophtalmopathy and dysthyroid optic neuropathy: Imaging studies for diagnosis

The diagnosis of Graves’ ophtalmopathy (GO) is based on clinical examination, laboratory tests (indicating thyroid dysfunction and inflammatory and autoimmune unbalance) and imaging studies (such computed tomography, magnetic resonance imaging, ultrasound and colour Doppler imaging). Imaging studies can be helpful in establishing the certain diagnosis of GO, because they provide objective morphological findings of the orbital structures. An important role of imaging studies is revealed in differential diagnosis versus other orbital diseases and can be also used to evaluate the progression of the disease and follow-up after clinical or surgical treatment.</jats:p

COMPUTED TOMOGRAPHY FOR DIAGNOSING GRAVES OPHTALMOPATHY

Graves ophtalmopathy (GO), thyroid eye disease (TED) and thyroid - associated orbitopathy (TAO) are terms referring to an autoimmune inflammatory process that affects the adipogenesis of orbital fat and periorbital tissue, associated with dysthyroidism. On imaging, such as computed tomography (CT) thyroid -associated orbitopathy (or thyroid -associated ophtalmopathy) is characterised by symmetrical and bilateral proptosis, secondary to extra-ocular muscle (EOM) enlargement and expansion of orbital fat. Imaging studies ca be useful in identifying patients risk to develop dysthyroid optic neuropathy and initiating early treatment of the condition, avoiding permanent visual loss. The purpose of this study was to reveal the prevalence of thyroid ophtalmopathy imaging considerations in Graves disease patients. A total of 19 patients were evaluated on computed tomography scanning the diameters and density of extra-ocular muscles, muscular index, proptosis, width of the optic nerve, width of superior ophthalmic vein and lacrimal gland position.</jats:p