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Endogenous ocular nocardiosis
George Castle1, Gregory Heath1
1York General Hospital, Ophthalmology Department, York, United Kingdom.
GMS Ophthalmology Cases
|June 14, 2021
Summary
Nocardiosis, a rare bacterial infection, can be fatal in immunocompromised patients. Subretinal abscesses may signal widespread infection, even with normal vital signs.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Immunology
Background:
- Nocardiosis is a rare, opportunistic Gram-positive bacterial infection with high mortality in immunocompromised individuals with disseminated disease.
- Giant cell arteritis is an autoimmune condition often treated with high-dose corticosteroids, increasing infection risk.
Observation:
- An elderly female patient with giant cell arteritis on corticosteroids developed ischaemic optic atrophy.
- The patient subsequently developed subretinal lesions and was diagnosed with pulmonary nocardiosis with widespread dissemination.
Findings:
- Subretinal abscesses can be an early indicator of serious, undiagnosed systemic infections.
- Immunocompromised patients may present with seemingly normal vital signs despite severe disseminated infections.
Implications:
- Ophthalmologists should consider disseminated infections like nocardiosis in patients with subretinal lesions, especially if immunocompromised.
- Early recognition and diagnosis of opportunistic infections are critical for improving outcomes in immunocompromised patients.
- High-dose corticosteroid therapy necessitates vigilant monitoring for opportunistic infections.
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