A 48-year-old male was investigated in a medical unit for fever and a productive cough of 2 weeks duration. He had diabetes and history of tuberculosis (TB) bronchiectasis. Initial investigations showed a neutrophil leucocytosis, an erythrocyte sedimentation rate (ESR) of 110 mm/first hour and a chest radiograph that revealed patchy consolidation in the right-upper zone and changes consistent with post-TB bronchiectasis and fibrosis. These findings were confirmed subsequently by high-resolution chest computed tomography (HRCT). Sputum samples were negative for acid fast bacilli, TB polymerase chain reaction (PCR) and pyogenic culture. However, a blood culture was positive for K. pneumonia, and he was started on intravenous cefotaxime based on the antibiotic sensitivity pattern.
He was subsequently investigated for non-specific abdominal pain with abdominal ultrasonography and a contrast-enhanced CT which showed bilobar hypo-dense liver lesions in the arterial phase that became iso-dense during venous phase. Furthermore, lesions enhancing in the arterial phase were also noted in the right lobe of prostate (Figure 1). Digital rectal examination of prostate did not reveal any significant abnormality, and his prostate-specific antigen (PSA) level was 3.2 ng/l. Upper and lower gastrointestinal endoscopy was normal and a liver biopsy or aspirate was planned. While awaiting this, he developed an acute unilateral painful red eye with rapidly worsening visual acuity. A diagnosis of acute endophthalmitis was made, and the vitreous aspirate was positive for K. pneumoniae.
A subsequent abdominal CT scan showed partial resolution of the liver lesions but enlargement of the prostatic lesion that now resembled a prostatic abscess (Figure 2). Following 14 days of intravenous ceftriaxone antibiotic therapy and intravitreal injection of antibiotics, clinical and ultrasonic resolution of the hepatic and prostatic abscesses was noted, in addition to the normalisation of his inflammatory markers. Unfortunately, the endophthalmitis resulted in permanent loss of vision in the left eye, and enucleation was not performed as patients wish. He was discharged after a hospital stay of one and half months and is under follow-up as an outpatient.