Bilateral Endogenous Nocardia Endophthalmitis: A Case Report

This report describes a case of presumed bilateral endogenous Nocardia endophthalmitis in order to guide clinicians in recognizing and treating this atypical etiology of ocular infection. A 56-year-old woman with a history of renal transplant presented with bilateral subretinal abscesses in the setting of a subcarinal infection with cultures positive for Nocardia. She was treated with serial intravitreal injections of amikacin for presumed bilateral endogenous Nocardia endophthalmitis with clinical improvement. Visual acuities were 20/200 in the right eye and 20/30 in the left eye approximately 6 months after initial presentation. Amikacin appears to be the drug of choice for treatment of Nocardia ocular infections. Endogenous Nocardia endophthalmitis tends to present differently than its exogenous counterpart, with the former subtype tending to present in a more indolent manner with choroidal abscesses. Providers should maintain a high suspicion for Nocardia as a potential etiology of ocular infection in immunocompromised patients.