<p>Endogenous <em>Nocardial</em> Endophthalmitis Misdiagnosed as Giant Cell Arteritis</p>

Abstract

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.

Periocular Infection With Nocardia nova Following Dacryocystorhinostomy With Silicone Stent Intubation

“…Currently, there are five published reports including chronic conjunctivitis, keratitis, endogenous and post traumatic endophthalmitis, and anterior scleritis. 2–6 The majority of these cases include immunocompetent patients acquiring infection through exogenous routes. Interestingly, Nocardia infection is usually described after penetrating corneal trauma or ocular contact with plants and soils.…”

“…The scientific literature contains only 5 reported cases of Nocardia nova causing ophthalmic infection. 2–6…”