Isolated endogenous Nocardia endophthalmitis after immunosuppression

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Endogenous endophthalmitis is a severe intraocular infection.
• Immunosuppression, particularly from chronic steroid use, increases susceptibility to opportunistic infections.
• Nocardia species are aerobic actinomycetes known to cause opportunistic infections.

Purpose of the Study:

• To report a rare case of endogenous Nocardia endophthalmitis.
• To highlight the association between chronic steroid use and this serious intraocular infection.
• To emphasize the diagnostic and therapeutic considerations for Nocardia endophthalmitis in immunosuppressed individuals.

Main Methods:

• A case report methodology was employed.
• Clinical presentation, ophthalmic examination findings, and microbiological cultures were documented.
• Treatment involved a combination of intravitreal and oral antimicrobial therapy, along with surgical intervention for retinal detachment.

Main Results:

• A 79-year-old female presented with decreased vision and floaters.
• Ophthalmic findings included severe anterior chamber inflammation, vitreous opacities, and retinal detachment.
• Vitreous cultures confirmed Nocardia farcinica infection without evidence of systemic spread. The patient achieved a stable condition post-treatment.

Conclusions:

• Nocardia endophthalmitis is a rare but serious condition.
• It should be considered in the differential diagnosis of intraocular infections in immunosuppressed patients, including those on steroids.
• Early diagnosis and appropriate management are crucial for favorable outcomes.