Community acquired klebsiella pneumoniae, K1 serotype. invasive liver abscess with bacteremia and endophthalmitis

A community-acquired syndrome of cryptogenic invasive Klebsiella pneumoniae [K. pneumoniae] liver abscess [CIKPLA] has been emerging worldwide over the past 3 decades, particularly in Taiwan and Korea. It is caused by highly virulent hypermucoviscous, rmpA positive K. pneumoniae serotype K1. This condition occurs in predominantly diabetic persons with no underlying hepatobiliary disease. Metastatic infections of the brain, meninges, lungs, pleura, bones, soft tissues, and eyes are unique features of this syndrome. We report a laboratory-confirmed regulator of mucoid phenotype [rmp]A-positive, K1 serotype K. pneumoniae from Saudi Arabia in 2 diabetic native Saudis presenting with community acquired, invasive liver abscess complicated in one by endogenous endophthalmitis. Following medical and surgical treatment, both patients were cured from liver abscesses, however there was unilateral permanent visual loss in one patient

Endocarditis caused by Abiotrophia defectiva

A 35-year-old man with pre-existing rheumatic heart disease and aortic regurgitation [AR] presented with intermittent fever, ankle swelling and clinical evidence of endocarditis. Transoesophageal echocardiogram [TEE] revealed vegetations and destruction of the aortic valve [AV]. Blood cultures grew a gram positive coccobacillus which was phenotypically identified as Abiotrophia defectvia [A.defectiva]. A diagnosis of infective endocarditis [IE] due to A.defectiva was made. Treatment, with penicillin and gentamicin, was administered for 4 weeks. Mechanical valve replacement was required few days after starting the antibiotic therapy. The patient had a favorable outcome on follow up. Although A.defectiva is an uncommon cause of endocarditis, early and correct identification of this pathogen is important to improve the outcome and the prognosis of patients with IE due to this organism

Isolated brain stem tuberculoma presenting with one and a half syndrome

In this report, we describe a patient with left conjugate gaze palsy and internuclear ophthalmoplegia on the opposite gaze one-and-a-half-syndrome [1 1/2 syndrome]. Magnetic resonance imaging of the brain showed nodular enhancing brain stem lesions. After excluding other potential diseases, tuberculoma was thought to be the underlying etiology. Recovery was achieved 8 weeks after initiation of anti-tuberculous anti-TB therapy. The isolated nature of the tuberculoma and the association with this rare syndrome is highlighted