Endogenous Nocardia Nova Panophthalmitis Masquerading as Malignancy: A Clinicopathologic Report

Area of Science:

• Ophthalmology
• Infectious Diseases
• Nephrology

Background:

• Endogenous Nocardia infections are rare, particularly in immunocompromised individuals.
• Panophthalmitis can present with varied signs, including intraocular and orbital inflammation.

Purpose of the Study:

• To document a case of endogenous Nocardia nova panophthalmitis.
• To highlight the presentation of Nocardia infection as a choroidal lesion with orbital signs in an immunosuppressed patient.

Main Methods:

• Retrospective case review.
• Ophthalmic examination, orbital imaging, and fine-needle aspiration biopsy.
• Histopathological analysis and broad-range polymerase chain reaction (PCR) for Nocardia identification.

Main Results:

• A 71-year-old female with a renal transplant on immunosuppression developed eye pain, vision loss, and a choroidal mass.
• Biopsy confirmed Nocardia nova in a new mass on the transplanted kidney.
• Enucleation revealed panophthalmitis with a choroidal abscess caused by Nocardia.

Conclusions:

• Endogenous nocardiosis should be suspected in immunosuppressed patients with intraocular masses and orbital inflammation, even without typical infection signs.
• Early recognition and management of Nocardia infections can improve outcomes, despite potential need for enucleation.