Post-traumatic exogenous endophthalmitis caused by Nocardia farcinica

Abstract

A case report of post-traumatic exogenous endophthalmitis caused by Nocardia farcinica, including treatment procedures, microbiology examination, and systemic medications. A 23-year-old male suffered a penetrating corneal injury that was treated with sutures. On the thirteenth day after the final suture was removed, an anterior uveitis developed and progressed to whitish, plump, nodular, and tufted exudates within the anterior chamber over the next 10 days; this led to an indication for intraocular surgery. Anterior chamber lavage and resection of solid fibrinous exudates (using a vitrectomy knife) for a complete microbiological examination were performed. Nocardia farcinica was identified. Systemic medications were chosen according to sensitivity, and a fixed combination of sulfamethoxazole 400 mg/trimethoprim 80 mg was administered long-term (months). In this case, accurate, early detection of an atypical infectious agent and determination of its sensitivity to antibiotic treatment enabled effective treatment that achieved the best functional and anatomical results under the circumstances.

Nocardia keratitis presenting as an anterior chamber ball of exudates and its management

“…Burdová et al reported a similar case of post-traumatic exogenous endophthalmitis caused by N. farcinica that required systemic drugs for a prolonged amount of time (12 months) due to the involvement of iris tissue and the anterior lens capsule. Only after a later microbiological sample yielded a negative result; was the oral sulfamethoxazole/trimethoprim combination discontinued 12. While some cases required more than 3 months of systemic medication,13 other authors have reported favourable outcomes for N. endophthalmitis after 6–10 weeks of oral therapy 14 30.…”