Klebsiella Pneumoniae Endogenous Endophthalmitis Mimicking a Choroidal Neovascular Membrane with Subretinal Hemorrhage.

BACKGROUND: Klebsiella endogenous endophthalmitis (EE) is commonly seen in patients with hepato-biliary disease and urinary tract infections. Subretinal abscess with vitreous cells is the usual presentation and requires intensive treatment with systemic and intravitreal antibiotics along with prompt vitrectomy. Subretinal hemorrhage surrounding a choroidal mass has not been reported as the presenting feature of endogenous bacterial endophthalmitis.

METHODS: We report a patient with chronic liver disease who developed Klebsiella pneumoniae EE secondary to urinary tract infection that mimicked a choroidal neovascular membrane (CNVM) with subretinal bleed.

RESULTS: Klebsiella EE was successfully managed with multiple intravenous and intravitreal injections of piperacillin/tazobactum, without the need for vitrectomy.

CONCLUSIONS: In patients with coagulopathy due to liver disease, EE may present with submacular hemorrhage mimicking a CNVM. Clinicians must be cognizant of this fact as delay in instituting appropriate antibiotic therapy can lead to loss of the eye.