Isolated endogenous Nocardia endophthalmitis after immunosuppression

Abstract

Purpose: This study is aimed to report a case of endogenous Nocardia endophthalmitis in the setting of immunosuppression from chronic steroid use.

Methods: A case report was conducted.

Results: A 79-year-old woman presented with decreased vision with floaters in the left eye. Ophthalmic examination revealed severe inflammation in the anterior chamber, vitreous opacities, and retinal detachment. Vitreous cultures grew Nocardia farcinica without any systemic foci of infection found during further workup. The patient was treated with intravitreal amikacin and oral trimethoprim-sulfamethoxazole, and her retinal detachment was later repaired in the operating room. The patient has since remained stable with no signs of retinal detachment or active infection.

Conclusions: Nocardia endophthalmitis is a rare, but serious intraocular infection that should be considered in the differential diagnosis in any immunosuppressed patient, including those receiving steroids, who presents with signs of intraocular infection.

Fig. 1

Exam findings at initial presentation. a Slit-lamp photograph shows inflammation in the anterior chamber with fibrin formation, poorly dilated pupil, and early rubeosis (arrow). b B-scan ultrasonography reveals vitreous opacities (asterisk) and partial retinal detachment with subretinal fluid (arrow)

Fig. 2

Gomori methenamine silver stain of the subretinal mass reveals numerous organisms (original magnification × 400). Inset: Characteristic filamentous and bacillary morphology of these organisms is consistent with Nocardia (original magnification × 1000)