Invasive Klebsiella syndrome with coexisting fungal endophthalmitis

Endogenous endophthalmitis accounts for approximately 5 - 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled diabetes mellitus who presented with fever and generalised body weakness for one week. He was diagnosed with invasive Klebsiella syndro...

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Autores principales:	Jayanthi Sugantheran, Zunaina Embong, Wan Mariny Md Kasim, Norlaila Talib
Formato:	article
Lenguaje:	EN
Publicado:	Academy of Family Physicians of Malaysia 2021
Materias:	endophthalmitis klebsiella syndrome fungal ball sphenoid mycetoma Medicine R
Acceso en línea:	https://doaj.org/article/4709dbc8a6514fa189c80d459018786c
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spelling	oai:doaj.org-article:4709dbc8a6514fa189c80d459018786c2021-12-04T07:23:06ZInvasive Klebsiella syndrome with coexisting fungal endophthalmitis10.51866/cr11001985-2274https://doaj.org/article/4709dbc8a6514fa189c80d459018786c2021-07-01T00:00:00Zhttps://e-mfp.org/wp-content/uploads/v16n2-CR-Invasive-Klebsiella-syndrome-with-coexisting-fungal-endophthalmitis.pdfhttps://doaj.org/toc/1985-2274Endogenous endophthalmitis accounts for approximately 5 - 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled diabetes mellitus who presented with fever and generalised body weakness for one week. He was diagnosed with invasive Klebsiella syndrome based on blood culture with presence of bilateral pleural effusion, liver abscess, renal impairment and sphenoidal sinusitis. The patient developed sudden bilateral painless reduced vision on day two of admission. Ocular examination revealed bilateral severe anterior chamber reaction and severe vitritis that obscured the view of the fundus. Ocular B-scan ultrasonography showed multiple loculations in the posterior segment in both eyes. There was soft tissue density with calcification in the left sphenoid sinus on computed tomography of the orbit. He was treated for bilateral endogenous endophthalmitis with multiple intravitreal antibiotic injections, but showed no improvement. Functional endoscopic sinus surgery was performed and revealed that the left sphenoid sinus was filled with fungal balls. Following drainage of sphenoidal pus, there was resolution of vitritis and fundus examination showed features of underlying fungal infection with a “string of pearls” present along the vascular arcade of both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. In addition to repeated intravitreal antibiotic injections, he was also treated with systemic and topical antifungal therapy. At three months post treatment, the infection resolved and his vision improved from counting fingers to 6/36 bilaterally.Jayanthi SugantheranZunaina EmbongWan Mariny Md KasimNorlaila TalibAcademy of Family Physicians of Malaysiaarticleendophthalmitisklebsiella syndromefungal ballsphenoid mycetomaMedicineRENMalaysian Family Physician, Vol 16, Iss 2, Pp 94-97 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	endophthalmitis klebsiella syndrome fungal ball sphenoid mycetoma Medicine R
spellingShingle	endophthalmitis klebsiella syndrome fungal ball sphenoid mycetoma Medicine R Jayanthi Sugantheran Zunaina Embong Wan Mariny Md Kasim Norlaila Talib Invasive Klebsiella syndrome with coexisting fungal endophthalmitis
description	Endogenous endophthalmitis accounts for approximately 5 - 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled diabetes mellitus who presented with fever and generalised body weakness for one week. He was diagnosed with invasive Klebsiella syndrome based on blood culture with presence of bilateral pleural effusion, liver abscess, renal impairment and sphenoidal sinusitis. The patient developed sudden bilateral painless reduced vision on day two of admission. Ocular examination revealed bilateral severe anterior chamber reaction and severe vitritis that obscured the view of the fundus. Ocular B-scan ultrasonography showed multiple loculations in the posterior segment in both eyes. There was soft tissue density with calcification in the left sphenoid sinus on computed tomography of the orbit. He was treated for bilateral endogenous endophthalmitis with multiple intravitreal antibiotic injections, but showed no improvement. Functional endoscopic sinus surgery was performed and revealed that the left sphenoid sinus was filled with fungal balls. Following drainage of sphenoidal pus, there was resolution of vitritis and fundus examination showed features of underlying fungal infection with a “string of pearls” present along the vascular arcade of both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. In addition to repeated intravitreal antibiotic injections, he was also treated with systemic and topical antifungal therapy. At three months post treatment, the infection resolved and his vision improved from counting fingers to 6/36 bilaterally.
format	article
author	Jayanthi Sugantheran Zunaina Embong Wan Mariny Md Kasim Norlaila Talib
author_facet	Jayanthi Sugantheran Zunaina Embong Wan Mariny Md Kasim Norlaila Talib
author_sort	Jayanthi Sugantheran
title	Invasive Klebsiella syndrome with coexisting fungal endophthalmitis
title_short	Invasive Klebsiella syndrome with coexisting fungal endophthalmitis
title_full	Invasive Klebsiella syndrome with coexisting fungal endophthalmitis
title_fullStr	Invasive Klebsiella syndrome with coexisting fungal endophthalmitis
title_full_unstemmed	Invasive Klebsiella syndrome with coexisting fungal endophthalmitis
title_sort	invasive klebsiella syndrome with coexisting fungal endophthalmitis
publisher	Academy of Family Physicians of Malaysia
publishDate	2021
url	https://doaj.org/article/4709dbc8a6514fa189c80d459018786c
work_keys_str_mv	AT jayanthisugantheran invasiveklebsiellasyndromewithcoexistingfungalendophthalmitis AT zunainaembong invasiveklebsiellasyndromewithcoexistingfungalendophthalmitis AT wanmarinymdkasim invasiveklebsiellasyndromewithcoexistingfungalendophthalmitis AT norlailatalib invasiveklebsiellasyndromewithcoexistingfungalendophthalmitis
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Invasive Klebsiella syndrome with coexisting fungal endophthalmitis

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