Nocardia asteroides subretinal abscess in patient with acute myelogenous leukemia after allogeneic stem cell
Marina A Eisenberg1, Shawn C Wilker
1Department of Ophthalmology, University Hospitals Case Medical Center, Cleveland, Ohio.
Purpose:
Nocardia asteroides is the most common bacterial cause of subretinal abscesses; however, the diagnosis is often delayed because of the lack of suspicion leading to poor visual prognosis and possible enucleation.
Methods:
A 40-year-old man with a history of allogeneic stem cell transplant presents with decreased vision and a macular subretinal abscess.
Results:
Examination revealed decreased vision at 20/100 with a peripapillary creamy subretinal lesion extending to the nasal margin of the fovea associated with intraretinal and subretinal hemorrhages without vitritis. Workup revealed disseminated N. asteroides, confirmed with a skin biopsy with the involvement of skin, eyes, lungs, and brain. Intravitreal amikacin and vancomycin were promptly given along with systemic vancomycin, sulfamethoxazole/trimethoprim, and meropenem. Vision improved rapidly to 20/40 with stabilization and eventual scarring of the lesion.
Conclusion:
This case illustrates that rapid diagnosis and treatment of subretinal N. asteroides can possibly have a good visual outcome and stabilization of the ocular manifestations.
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