Scleritis Caused by In Vitro Linezolid-Resistant Nocardia asteroides. (23rd October 2014)

• Record Type: Journal Article
• Authors: Gonzalez, Andres; Fakhar, Kaihan; Gubernick, David; Tuli, Sonal
• Other Names: Eguchi Hiroshi Academic Editor.
• Is Part Of: Case reports in ophthalmological medicine. Volume 2014(2014)
• Publication Date: 2014-10-23
• Subjects: Ophthalmology -- Periodicals; Eye -- Diseases -- Periodicals; Ophthalmology; Eye Diseases; Eye -- Diseases; Ophthalmology; Electronic journals; Periodicals; Periodicals; Case Reports; Fulltext; Internet Resources; Periodicals; 617.7
• DOI: 10.1155/2014/326957
• Languages: English
• ISSNs: 2090-6722

Abstract

Abstract : Purpose . To describe a case of postoperative scleritis caused by a novel strain of Nocardia resistant to linezolid and trimethoprim-sulfamethoxazole (TMP-SMX). Methods . Case report of a patient with microbiologically proven scleritis due to Nocardia asteroides . Results . The patient presented with pain, redness, and nodules on the sclera three months following pterygium excision with mitomycin C and amniotic membrane placement. As no response was noted with empiric treatment for bacterial scleritis, debridement was performed. The cytopathology report showed gram positive filamentous bacteria. A presumptive diagnosis of Nocardia scleritis was made and therapy was initiated based on a literature review on treatments for Nocardia infections. Cultures returned growing Nocardia asteroides . Antibiotic sensitivity testing revealed resistance to linezolid and TMP-SMX which are the traditional drugs of choice for Nocardia . The patient was treated with amikacin and imipenem as well as extensive debridement with pedicle grafts. The patient's scleritis resolved with a good visual outcome. Conclusions . Cultures should be obtained in all cases of necrotizing scleritis in patients with a recent history of conjunctival surgery to rule out unusual organisms such as Nocardia . Although literature states that resistance to linezolid and TMP-SMX is rare in Nocardia, sensitivity testing can be useful in unresponsive cases.