Endogenous nocardial endophthalmitis in an immunosuppressed patient: A serious warning of an underlying life threatening and blinding disorder

Abstract

Purpose:To report a case of bilateral endogenous nocardial endophthalmitis with central nervous system involvement in an immunocompromised individual with an extremely poor outcome.Case Report:A 35-year-old man with a history of long-term, prescribed oral steroid use for membranoproliferative glomerulonephritis presented with profound bilateral vision loss. Patient's diagnosis of bilateral endogenous nocardial endophthalmitis was delayed. Nocardia was finally isolated from a brain biopsy after a repeat magnetic resonance imaging revealed a brain abscess. With anti-nocardia therapy, patient improved systemically, but the visual outcome was poor, with no light perception in both eyes.Conclusion:Ocular nocardiosis is a serious vision and life threatening disorder, particularly in patients on immunosuppressive therapy. A high index of suspicion is required for successful treatment.

Disseminated Nocardiosis with retinal abscess in a patient treated for bullous pemphigoid

“…MRI Brain can also demonstrate ring-enhancing lesions indicative of Nocardia, as in this patient. 9 In this case, the typical MRI findings together with positive brain biopsy established the clinical diagnosis of Nocardia farcinica , allowing for more appropriate antibacterial management. Treatment initially involves systemic sulfonamide therapy, as was conducted for this patient.…”

Endogenous ocular nocardiosis

“…It is widely held that the earlier the diagnosis is made, the greater the chance of patient recovery [ 4 ]. The later the diagnosis, the worse the visual prognosis [ 5 ]. Therefore, Nocardia must be included in the differential diagnosis of patients that present with signs of intraocular infection, who are immunosuppressed [ 6 ].…”