高毒力肺炎克雷伯菌引起的严重脓毒症致内源性眼内炎1例

Endogenous endophthalmitis is a rare and severe complication in sepsis with poor prognosis.Last year,a 51-years-old male admitted to our emergency department due to high fever,breathless and visual impairment.A clinical diagnosis of severe sepsis complicated with pneumonia,diabetes,thrombophlebitis and endophthalmitis was made based on clinical manifestations,laboratory data,imaging detection and ophthalmologic examination.At the same time,hematogenous infection caused by a subtype of hypervirulent Klebsiella pneumoniae (HvKP) was identified by applying blood culture and molecular biology detection method.Besides,HvKP species bacteremia leaded to severe endogenous endophthalmitis and profound thrombocytopenia.However,most of the septic symptoms were improved due to evidence-based empiric antibiotic therapy except for the impaired vision.The patient and his family refused to accept either diagnostic vitrectomy or surgical intervention,and the patient discharged later.We recommend that emergency physicians should recognize the ocular symptoms result from severe sepsis,and keep awareness on the atypical clinical features in the earlier stage of the disease course,because prompt ophthalmologic diagnosis and managements may improve the outcome.