Nocardia asteroides subretinal abscess in patient with acute myelogenous leukemia after allogeneic stem cell transplant

Endogenous Nocardial Endophthalmitis Misdiagnosed as Giant Cell Arteritis

Purpose

Endogenous endophthalmitis is uncommon but potentially dangerous. We present a fatal presentation of endogenous Nocardial endophthalmitis in the context of steroid use for treatment of giant cell arteritis.

Case Presentation

An 84-year-old Caucasian female presented to the local emergency room with severe headaches, myalgia and shoulder and calf muscle pain. She was treated for a presumed diagnosis of giant-cell arteritis with corticosteroids and subsequently developed an intense retro-orbital pain in the right eye. Fundus examination revealed a white, vascularized chorioretinal mass at the equator of the eye in the inferotemporal quadrant. Antibiotics were given and a vitrectomy was performed. The culture of the vitreous showed Nocardia nova and a diagnosis of disseminated Nocardiosis was made.

Conclusion and Significance

Although uncommon, it is important that ophthalmologists are aware of Nocardial infections as a differential diagnosis of retinal mass, particularly in immunocompromised patients.

A case report of disseminated nocardiosis with ocular involvement in a myasthenia gravis patient and literature review

Background

Nocardiosis is a rare and life-threatening opportunistic infection in immunocompromised patients. Myasthenia gravis (MG) patients are potentially at risk of nocardia infection because of the use of immunosuppressive agents. To date, only 7 patients with MG have been reported to have nocardiosis. Disseminated nocardiosis with ocular involvement has not been reported in MG patients.

Case presentation

A 66-year-old man with MG who was receiving treatment with methylprednisolone and azathioprine was found to have a respiratory infection. He also had heterogeneous symptoms with skin, brain and ocular manifestations. Nocardia bacteria verified by the culture of puncture fluid, and a diagnosis of disseminated nocardiosis was made. Except for left eye blindness, the patient completely recovered from the disease with combination antibiotic therapy. To further understand nocardiosis in patients with MG, we reviewed the previous relevant literature. According to the literature, this is the first report of disseminated nocardiosis with ocular involvement in an MG patient.

Conclusions

MG patients with immunosuppressant treatments are potentially at risk of a rare nocardia infection, and a favourable prognosis can be achieved through early diagnosis and appropriate antibiotic therapy.

A case of endogenous endophthalmitis with subretinal abscess secondary to splenic abscess

Early diagnosis and treatment of endophthalmitis will optimise visual prognosis. Blood culture sensitivities should tailor antibiotic choice.

Intralesional antibiotic injection using 41G needle for the management of subretinal abscess in endogenous endophthalmitis

BACKGROUND

Presence of subretinal abscess in endogenous endophthalmitis indicates a more severe form of infection. Available reports indicate variable response to standard treatment with systemic, intravitreal pharmacotherapy and vitreous surgery. There are no reports citing the possible role of intralesional antibiotic therapy in managing subretinal abscess.

CASE PRESENTATION

A 30 year old lady presented with features of endogenous endophthalmitis and subretinal abscess. Presenting vision was finger counting close to face. Despite prompt initiation of systemic antibiotics and intravitreal injection, no response was noted. 25G pars plana vitrectomy was performed along with injection of vancomycin directly into the subretinal abscess, using a 41G needle. Postoperative course was uneventful and the abscess showed signs of rapid resolution. Visual acuity improved to 6/24.

CONCLUSION

Intralesional pharmacotherapy may be safe and effective in the treatment of subretinal abscess associated with endogenous endophthalmitis.