Post-traumatic exogenous endophthalmitis caused by Nocardia farcinica

Abstract

A case report of post-traumatic exogenous endophthalmitis caused by Nocardia farcinica, including treatment procedures, microbiology examination, and systemic medications. A 23-year-old male suffered a penetrating corneal injury that was treated with sutures. On the thirteenth day after the final suture was removed, an anterior uveitis developed and progressed to whitish, plump, nodular, and tufted exudates within the anterior chamber over the next 10 days; this led to an indication for intraocular surgery. Anterior chamber lavage and resection of solid fibrinous exudates (using a vitrectomy knife) for a complete microbiological examination were performed. Nocardia farcinica was identified. Systemic medications were chosen according to sensitivity, and a fixed combination of sulfamethoxazole 400 mg/trimethoprim 80 mg was administered long-term (months). In this case, accurate, early detection of an atypical infectious agent and determination of its sensitivity to antibiotic treatment enabled effective treatment that achieved the best functional and anatomical results under the circumstances.

Keywords: Nocardia farcinica; Post-traumatic endophthalmitis.

Fig. 1

Post-traumatic corneal scar. Mild non-granulomatous anterior uveitis with fibrin in the anterior chamber. The nodular exudates grew anteriorly towards the corneal endothelium and imitated an iris cyst (a). A hypopyon in the anterior chamber and white, plump, fluffy hemispherical exudates progressing into the anterior chamber (b). Whitish, plump, nodular, and tufted exudates continued to develop within the anterior chamber (c). The eye 5 years after cataract surgery. The eye is completely without signs and symptoms of inflammation and the patient is without any local and systemic medications (d)

Fig. 2

Microscopy using white light source (a), Gram stain (b), and Calcofluor white staining (c) of Nocardia filaments