Endogenous Endophthalmitis Heralding Central Nervous System Involvement by Nocardia Farcinica

Nocardiosis is an uncommon opportunistic infection caused by aerobic, gram-positive, weakly acid-fast, filamentous bacteria of the genus Nocardia that presents as a suppurative disease in immunocompromised hosts. Herein the authors describe the case of an elderly male with granulomatosis with polyangiitis (GPA) on chronic immunosuppressive therapy that presented initially with visual symptoms and developed focal neurological deficits. Nocardia should be considered as a potential pathogen in any immunosuppressed patient presenting with endogenous endophthalmitis and new-onset focal neurological deficits. Early recognition and treatment may prevent irrevocable neurological compromise stemming from misdiagnosis.