A Man with Pulmonary Nodules, Liver Mass, and Vision Loss

Symptoms started with vomiting and diarrhea 3 weeks before presentation. Imaging identified >15 pulmonary nodules, a solid-cystic hepatic mass, septic thrombophlebitis, and diffuse cerebral lesions. Eye exam showed severe orbital cellulitis (see Figure 1), fibrin in the anterior chamber, and vitreous opacities in the right eye. Despite intravenous and intravitreal antibiotics, vision did not improve, necessitating eye enucleation. Cultures and pathology eventually identified hypervirulent Klebsiella pneumoniae.