A Case of Metastatic Endophthalmitis Resulting from Liver Abscess Complicated with Pyogenic Ventriculitis via Optic Nerve

Intracranial extension of infection via the optic nerve is a rare but serious complication of bacterial endophthalmitis.A 79-year-old women was hospitalized complaining of right eyelid swelling, severe hyperemia and purulent conjunctival discharge in the right eye. Although the fundus was invisible due to cataract, right endophthalmitis of unknown origin was suggested by pus in the anterior chamber and brain computed tomography (CT) findings showing nasal scleral rupture and orbital cellulitis. Systemic examination revealed pyogenic liver abscess and percutaneous drainage of abscess disclosed Klebsiella pneumoniae, which was also isolated from conjunctival discharge. Because diffusion-weighted magnetic resonance imaging (MRI) findings demonstrated right optic neuritis and ventriculitis, enucleation of her right eye was performed based on the diagnosis of pyogenic ventriculitis via the optic nerve. Klebsiella pneumoniae was detected in both stumps of the transected right optic nerve. Despite intensive anti-bacterial treatment, she died of acute respiratory distress syndrome 46 days after hospitalization.Severe bacterial endophthalmitis may cause intracranial infection via the optic nerve.