Treatment of presumed Nocardia endophthalmitis and subretinal abscess with serial intravitreal amikacin injections and pars plana vitrectomy

Abstract

A 64-year-old man with a past medical history of liver transplantation on chronic immunosuppressive therapy presented with gradual worsening of vision over 2 months in his right eye. His recent history of Aspergillus and Nocardia pneumonia with positive bronchoalveolar lavage, in concert with vitritis and subretinal abscess, were concerning for endogenous endophthalmitis. A sputum culture and transbronchial lung biopsy stains grew Nocardia farcinica although aqueous humor sampling was negative. He was treated with four serial amikacin intravitreal injections over the course of 4 weeks. Pars plana vitrectomy for worsening macular traction and subsequent cataract surgery resulted in significant clinical and anatomic improvement of vision to 20/60 and consolidation of the subretinal abscess.

Post-Traumatic Exogenous Endophthalmitis Caused By Nocardia Farcinica

“…As with other infections, immunological status also plays a crucial role in Nocardiosis [21]. This was con rmed by an extensive retrospective study of the relationship between manifestations and outcomes of Nocardia infections relative to the immunocompetence of patients.…”

Post-traumatic exogenous endophthalmitis caused by Nocardia farcinica

“…As with other infections, immunological status also plays a crucial role in Nocardiosis [ 19 ]. This was confirmed by an extensive retrospective study of the relationship between manifestations and outcomes of Nocardia infections relative to the immunocompetence of patients.…”

Successful control of scleritis caused by Nocardia farcinica: A case report

“…It rarely causes severe purulent infection of the eyes, [ 1 ] which can be manifested as keratitis, [ 2 ] endophthalmitis, [ 3 ] scleritis, and chorioretinitis. [ 4 ] N. farcinica infection can be derived from exogenous sources, for example, trauma or endogenous sources, for example, hematogenous dissemination. The clinical symptoms lack specificity and immunocompromised population are susceptible to N. farcinica infection.…”

“…Of the few reports of N. farcinica eye infection, the therapeutic efficacy of mild keratitis is acceptable, while the efficacy for endophthalmitis is relatively poor. [3–5] In this study, we report a case of infectious scleritis involving the corneal limbus, which is suspected to be caused by N. farcinica in traumatic wound infection. The diagnosis was quickly and accurately confirmed by pathogenic microorganism culture and metagenomic sequencing.…”