A Case Report of Endogenous Endophthalmitis in the Setting of Nocardia kroppenstedtii Infection

Abstract

A woman with a past medical history of radiation and chemotherapy for multiple malignancies presented with bilateral, multifocal, elevated chorioretinal lesions associated with vitritis. The differential diagnosis included endogenous endophthalmitis and metastatic disease. Her extensive medical history and ill appearance at presentation in concert with vitritis and subretinal lesions was concerning for endogenous endophthalmitis. Although her vitreous sample was negative, her blood cultures were positive for Nocardia kropenstedtii and Nocardia farcinica . She was started on broad-spectrum antibiotic coverage but had brain lesions on presentation and ultimately passed away. This is the first reported case of Nocardia endophthalmitis in the setting of systemic N. kroppenstedtii infection. [ Ophthalmic Surg Lasers Imaging Retina. 2019;50:53–55.]

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

“…Although there was no positive growth from AC or vitreous cultures, our patient had positive sputum cultures that were sufficient to suggest a likely Nocardia etiology for endogenous endophthalmitis. In another study of a patient with a similar diagnosis, vitreous samples were negative but blood cultures were positive for Nocardia, suggesting that blood cultures in the setting of other systemic findings were important to diagnosis [4]. Thus, our case further demonstrates the utility of positive cultures from systemic sources to support a diagnosis of infectious endophthalmitis.…”