Bilateral Endogenous Nocardia Endophthalmitis: A Case Report.

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Endogenous Nocardia endophthalmitis is a rare but serious ocular infection.
• Immunocompromised patients, particularly those with a history of organ transplant, are at increased risk.
• Nocardia infections can present atypically in the eye, often with subretinal abscesses.

Purpose of the Study:

• To describe a case of presumed bilateral endogenous Nocardia endophthalmitis.
• To guide clinicians in the recognition and management of this unusual ocular infection.
• To emphasize the importance of considering Nocardia in the differential diagnosis of endophthalmitis in immunocompromised patients.

Main Methods:

• A case study of a 56-year-old female renal transplant recipient.
• Clinical presentation included bilateral subretinal abscesses secondary to a subcarinal Nocardia infection.
• Treatment involved serial intravitreal injections of amikacin.

Main Results:

• The patient showed clinical improvement following treatment with intravitreal amikacin.
• Visual acuities at 6 months post-presentation were 20/200 (right eye) and 20/30 (left eye).
• Nocardia endophthalmitis presented indolently with choroidal abscesses, differing from exogenous forms.

Conclusions:

• Amikacin is suggested as the drug of choice for Nocardia ocular infections.
• Endogenous Nocardia endophthalmitis typically presents with indolent choroidal abscesses.
• High clinical suspicion for Nocardia is warranted in immunocompromised patients with ocular infections.