Subretinal abscess as an initial presentation of systemic nocardiosis
Department of Medicine; Radiology; Ophthalmology
We report a case of subretinal abscess as the initial presentation of systemic nocardiosis. The patient was a known case of chronic inflammatory demyelinating polyneuropathy and on long-term immunosuppressants. He presented with a rapidly progressive, unilateral decline in visual acuity in the right eye. Dilated fundus examination showed a large whitish subretinal lesion. A working diagnosis of subretinal abscess was made. The appearance was highly suspicious for Nocardia abscess. On further direct questioning, it was noted that the patient had been experiencing low-grade fever and non-productive cough for 1 month. The patient was referred to infectious diseases for systemic work-up and a vitreous tap was done, along with intravitreal antibiotics. Blood culture and bronchoalveolar lavage both reported Nocardia species. Sensitivity-guided antibiotic therapy resulted in improved systemic condition and a quiet and comfortable right eye, but vision could not be saved due to late presentation.
BMJ Case Reports
Malik, M. B.,
Ahsan, N. J.,
Siddiqui, M. R.
(2020). Subretinal abscess as an initial presentation of systemic nocardiosis. BMJ Case Reports, 13(11), e236898.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_ophthalmol/62