Spontaneous Globe Rupture Of Panophthalmitis Secondary To Klebsiella Pneumoniae And Kocuria Palustris Infection

To present a rare case of right eye panophthalmitis with spontaneous globe rupture 14 days after admission, secondary to Klebsiella pneumoniae, Enterococcus faecalis and Kocuria palustris infection. 

A case of a 51-year-old male with a history of newly diagnosed type 2 diabetes mellitus and recent carbuncle rupture in the buttock who initially presented with fever, right eye swelling, and blurred vision.  The right eye panophthalmitis developed spontaneous globe rupture 14 days after admission, secondary to Klebsiella pneumoniae, Enterococcus faecalis and Kocuria palustris infection. 

a 51-year-old male presented with a three-day history of fever and blurred vision in the right eye. Before admission, the patient presented with a recent ruptured carbuncle on the buttock, which was treated with local antibiotics  but failed to alleviate symptoms. Physical examination revealed eye swelling, ptosis, and periorbital erythema. The unaided visual acuity of right eye measuring hand motion perception at a distance of 10 centimeters. Intraocular pressure was measured 10.5 mmHg (OD) and 15.5 mmHg (OS). Lab data also indicated infectious status. Initial CT on day 6 of admission showed suspected panophthalmitis of the right eye with measurable intraocular pressure. Blood cultures and pus cultures from a deep abscess both identified gram-negative bacilli, specifically Klebsiella pneumoniae and Enterococcus faecalis. 

However, the patient had presented with persistent right temporal intermittent deep dull pain even under multiple antibiotics. Follow-up brain MRI revealed spontaneous rupture of the right globe and panophthalmitis along with undetectable intraocular pressure. On day 21, the patient underwent right eye debridement. Due to a range of necrosis extending past the equator and purulent vitreal inflammation, evisceration of eyeball with scleral graft was performed. Pus cultures from the vitreous body revealed a rare infection with Kocuria palustris. The surgery went smoothly without corneal leakage or discharge, and the patient was discharged in stable condition. 

We should aware that endogenous endophthalmitis cause by Klebsiella pneumoniae are more prominent and multi-drug resistenced than bfore. Our case revealed a concurrent bloodstream infection with K. pneumoniae and Enterococcus faecalis identified in the originating carbuncle and blood cultures, indicating a systemic infection seeding the eye. Additionally, the Kocuria palustris was also isolated from the vitreous fluid pus in this patient. It has been associated with several cases of bacteremia and corneal ulceration. Increasing reports of pathogenic infections caused by Kocuria species were also noted, including bacteremia , skin and soft tissue infections and  endophthalmitis, occurring disproportionately in immunocompromised patients.