Cunha LPD, Juncal V, Carvalhaes CG, Leão SC, Chimara E, Freitas D. Nocardial scleritis: A case report and a suggested algorithm for disease management based on a literature review.
Am J Ophthalmol Case Rep 2018;
10:1-5. [PMID:
29780901 PMCID:
PMC5956651 DOI:
10.1016/j.ajoc.2018.01.018]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 11/02/2017] [Accepted: 01/08/2018] [Indexed: 01/10/2023] Open
Abstract
Purpose
To report a case of nocardial scleritis and to propose a logical treatment algorithm based on a literature review.
Observations
It is important to suspect a nocardial infection when evaluating anterior unilateral scleritis accompanied by multiple purulent or necrotic abscesses, especially in male patients with a history of chronic ocular pain and redness, trauma inflicted by organic materials, or recent ophthalmic surgery. A microbiological investigation is essential. In positive cases, a direct smear reveals weakly acid-fast organisms or Gram-positive, thin, beading and branching filaments. Also, the organism (usually) grows on blood agar and Lowenstein-Jensen plates. An infection can generally be fully resolved by debridement of necrotic areas and application of topical amikacin drops accompanied by systemic sulfamethoxazole-trimethoprim.
Conclusions and significance
Together with the case report described, we review data on a total of 43 eyes with nocardial scleritis. Our proposed algorithm may afford a useful understanding of this sight-threatening disease, facilitating easier and faster diagnosis and management.
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