[Nocardia farcinica: life-threatening chorioiditis under systemic immunosuppression]

Immunosuppressed patients occasionally suffer from a multifocal infection with Nocardia. It is important to distinguish Nocardia farcinica from Nocardia asteroides, because of different sensitivity against antibiotics.

A 40-year-old patient with polycystic renal disease successfully underwent a kidney transplantation without complications. Immunosuppression consisted of: corticosteroids, azathioprin and ciclosporin A. Ten weeks later he developed acute choroiditis with consecutive retinal detachment and neovascular glaucoma in one eye. In addition, 14 weeks after transplantation CT scans revealed multiple cerebral abscesses.

In the course of the disease Nocardia farcinica (N. f.) was identified by cerebral stereotactic biopsy of a cerebral lesion, histological examination of the enucleated globe and sputum culture. Histologically filamentous, eosinophilic organisms were found. Microbiology identified aerobic actinomycetes in cultures and Nocardia farcinica by PCR. Therapeutically the combination of vancomycin, ampicillin, and sulbactam was successful.

In immunosuppressed patients Nocardia farcinica can become life-threatening. One of the first manifestations may be a choroiditis. Infection of the respiratory tract followed by hematogenous spread is the common way of systemic nocardiosis. Biopsy followed by identification of species by PCR is recommended because of the specific therapeutic strategies associated with each species.