Nosocomial Klebsiella pneumoniae conjunctivitis resulting in infectious keratitis and bilateral corneal perforation

Abstract

Purpose. Klebsiella pneumoniae is a known cause of metastatic endophthalmitis: However, the organism has never been described to cause severe infectious keratoconjunctivitis. We report a fulminant case of nosocomial K. pneumoniae conjunctivitis complicated by infectious keratitis and corneal perforation in both eyes. Methods. An 83-year-old previously healthy Chinese woman, blind in the right eye from rubeotic glaucoma and with bilateral dense cataracts, was admitted for observation after a head injury. While in hospital, she developed purulent bilateral conjunctivitis. Repeated cultures grew K. pneumoniae. This rapidly progressed to severe infectious keratitis and corneal perforation in both eyes, despite intensive antibiotics to which the organism was susceptible. The patient was otherwise well, and investigations did not reveal any source of endogenous sepsis. Results. The patient lost complete vision in both eyes. The left eye turned phthisical, and the right eye was eviscerated for uncontrolled endophthalmitis. Conclusion. Although not previously reported, K. pneumoniae can cause devastating keratoconjunctivitis resulting in corneal melt, perforation, and uncontrolled endophthalmitis.