Challenging Case of Postoperative Nocardia Endophthalmitis
Abstract
Purpose: To describe a case of postoperative Nocardia endophthalmitis that proved to be challenging. Methods: A 64-year-old woman presented with a clinical picture of postoperative endophthalmitis, which was managed by vitrectomy with intraocular lens explantation. Nocardia puris, sensitive to amikacin, cotrimoxazole (trimethoprim-sulfamethoxazole), and ciprofloxacin, was isolated in culture. The patient received intracameral and intravenous amikacin. On the sixth postoperative day, the infection appeared controlled; however, a macular infarction developed. One month later, the patient presented with recurrent infection (iris nodule and vitritis). After consultation with an infectious disease specialist, oral trimethoprim-sulfamethoxazole and oral moxifloxacin were started. Treatment continued for 6 months. Results: At the 3-month and 6-month follow-ups, the iris nodules had regressed in size with no new visible lesions. The vitreous cavity was clear, and the retina was attached; however, the best-corrected visual acuity was poor because of the macular infarction. Conclusions: This case highlights the importance of obtaining a microbiological diagnosis with sensitivity in cases of Nocardia endophthalmitis and its use in the aggressive management of the infection, including frequent monitoring for recurrences.
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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