Subretinal abscess as an initial presentation of systemic nocardiosis. Issue 11 (2nd November 2020)

• Record Type: Journal Article
• Authors: Malik, Muhammad Bilal; Ahsan, Nida Jawed; Hilal, Kiran; Mahmood, Syed Faisal; Siddiqui, M A Rehman
• Is Part Of: BMJ case reports. Volume 13:Issue 11(2020)
• Publication Date: 2020-11-02
• Subjects: retina -- infection (neurology) -- eye -- drugs: infectious diseases -- radiology; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2020-236898
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : 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.