{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:43:48Z","timestamp":1787010228857,"version":"build-2736575974"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:00:00Z","timestamp":1680307200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/ http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Diabetes mellitus is the most common endocrine metabolic disease. Uncontrolled diabetes affects almost all components of immunity. Diabetes mellitus patients have an increased susceptibility to infections which aggravates in the cases of uncontrolled hyperglycemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>\n                      The authors present the case of a 63-year-old female patient with a history of poorly controlled type 2 diabetes. She went to the ambulance complaining of fever, poor appetite, dyspnea, cough, fatigue, and asthenia. The chest computed tomography showed the presence of bilateral ovoid infiltration densities, mostly on the upper-right side. The initial diagnosis was community-acquired pneumonia in an immunocompromised host due to poorly controlled diabetes. A swelling was observed in the right cheek and around the right eye, along with ptosis of the right eyelid. The ophthalmologist indicated the presence of panophthalmitis of the entire right eye with optic neuritis and right orbital cellulitis. The bacterial culture of bronchoalveolar lavage showed Gram-negative bacteria known as\n                      <jats:italic toggle=\"yes\">Klebsiella<\/jats:italic>\n                      . After 17 days of hospitalization, the patient was discharged from the hospital on treatment with oral fluconazole, oral ciprofloxacin, and intramuscular gentamicin.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      In conclusion, the case highlights the importance of early detection of systematic infection manifestations in diabetic patients, regarding their age, history, and other comorbidities. Ocular symptoms are highly recommended to be evaluated in this context of\n                      <jats:italic toggle=\"yes\">Klebsiella<\/jats:italic>\n                      infection.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/ms9.0000000000000011","type":"journal-article","created":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T06:17:40Z","timestamp":1682662660000},"page":"913-917","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["A rare case of concomitant Klebsiella pneumonia and panophthalmitis in a poorly controlled diabetic patient: the first case report from Syria"],"prefix":"10.1097","volume":"85","author":[{"given":"Mohamad F.","family":"Kashkash","sequence":"first","affiliation":[{"name":"Faculty of Medicine"},{"name":"Pulmonology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9662-9492","authenticated-orcid":false,"given":"Zain","family":"Douba","sequence":"additional","affiliation":[{"name":"Faculty of Medicine"},{"name":"CME Office, Faculty of Medicine, University of Aleppo"},{"name":"Department of Hematology, Zahi Azrak Hospital, Ministry of Health Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samer H.","family":"Kaddour","sequence":"additional","affiliation":[{"name":"Faculty of Medicine"},{"name":"Laboratory Medicine, Aleppo University Hospital, Aleppo, Syria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulla","family":"Khouri","sequence":"additional","affiliation":[{"name":"Faculty of Medicine"},{"name":"Pulmonology"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,4]]},"reference":[{"key":"R1-20250806","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.diabres.2018.02.023","article-title":"IDF Diabetes Atlas: global estimates of diabetes prevalence for 2017 and projections for 2045","volume":"138","author":"Cho","year":"2018","journal-title":"Diabetes Res Clin Pract"},{"key":"R2-20250806","first-page":"442","article-title":"Type 2 diabetes and its impact on the immune system","volume":"16","author":"Berbudi","year":"2019","journal-title":"Curr Diabetes Rev"},{"key":"R3-20250806","doi-asserted-by":"crossref","first-page":"e00091","DOI":"10.1128\/CMR.00091-18","article-title":"Treating polymicrobial infections in chronic diabetic wounds","volume":"32","author":"Buch","year":"2019","journal-title":"Clin Microbiol Rev"},{"key":"R4-20250806","doi-asserted-by":"crossref","first-page":"107","DOI":"10.21315\/mjms2019.26.1.10","article-title":"The significant association between polymicrobial diabetic foot infection and its severity and outcomes","volume":"26","author":"Sharifah Aisyah","year":"2019","journal-title":"Malays J Med Sci"},{"key":"R5-20250806","first-page":"1875","article-title":"Endophthalmitis caused by Klebsiella species. Retina.","volume":"34","author":"Sridhar","year":"2014"},{"key":"R6-20250806","doi-asserted-by":"crossref","first-page":"e01289","DOI":"10.1016\/j.idcr.2021.e01289","article-title":"Case report","volume":"26","author":"Bouhout","year":"2021","journal-title":"IDCases"},{"key":"R7-20250806","first-page":"e15929","article-title":"Case series on endogenous Klebsiella pneumoniae endophthalmitis: more than meets the eye case presentation","volume":"13","author":"Danapal","year":"2021","journal-title":"Cureus."},{"key":"R9-20250806","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1097\/IPC.0000000000000842","article-title":"Klebsiella pneumoniae causing liver abscess, endophthalmitis, and cavitary pneumonia","volume":"28","author":"Doke","year":"2020","journal-title":"Clin Infect Dis."},{"key":"R10-20250806","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1136\/bjo.2007.132522","article-title":"Risk factors for endogenous Klebsiella endophthalmitis in patients with Klebsiella bacteraemia: a case \u2013 control study","volume":"92","author":"Sng","year":"2008","journal-title":"Br J Ophthalmol."},{"key":"R11-20250806","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1080\/08820538.2021.1954205","article-title":"Seminars in ophthalmology clinical features and mortality of endogenous panophthalmitis in China: a six-year study.","volume":"37","author":"Qi","year":"2022","journal-title":"Semin Ophthalmol"},{"key":"R12-20250806","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1186\/s12879-018-3543-5","article-title":"Endogenous endophthalmitis caused by a multidrug-resistant hypervirulent Klebsiella pneumoniae strain belonging to a novel single locus variant of ST23: first case report in China","volume":"18","author":"Xu","year":"2018","journal-title":"BMC Infect Dis"},{"key":"R13-20250806","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1186\/s12879-020-05390-z","article-title":"Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by liver abscess","volume":"20","author":"Wang","year":"2020","journal-title":"BMC Infect Dis."}],"container-title":["Annals of Medicine &amp; Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/MS9.0000000000000011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T13:26:29Z","timestamp":1754486789000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/MS9.0000000000000011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4]]},"references-count":12,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1097\/ms9.0000000000000011","relation":{},"ISSN":["2049-0801"],"issn-type":[{"value":"2049-0801","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4]]},"assertion":[{"value":"2022-08-06","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-12","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}