Diagnostic Challenge with Nocardia Subretinal Abscess: A Case Report from Tuberculosis-Endemic Region

Ocul Immunol Inflamm. 2019;27(5):762-765. doi: 10.1080/09273948.2018.1462391. Epub 2018 May 10.

Abstract

Purpose: To describe a case of Nocardia subretinal abscess, which posed a diagnostic challenge due to the presence of mycobacterial genome in sample obtained from fine needle aspiration biopsy (FNAB). Methods: A retrospective chart review. Results: A 25-year-old male presented with sudden, painless onset diminution of vision of left eye and found to have placoid patch of choroiditis just temporal to the macula in right eye and showed vitritis, subretinal abscess with exudative retinal detachment and vitreous hemorrhage in left eye. Both aqueous and vitreous samples were negative microbiologically and polymerase chain reaction for various genomes. Sample obtained from FNAB was positive for mycobacterial genome and yielded Nocardia arthritidis on culture. She was treated with antitubercular therapy and intravenous and intravitreal antimicrobials. Conclusions: Nocardia subretinal abscess can be a diagnostic challenge in tuberculosis-endemic region, especially in conditions when there is co-infection with Mycobacterium tuberculosis.

Keywords: Nocardia; Ocular Tuberculosis; Polymerase Chain Reaction; Subretinal Abscess; Vitrectomy.

Publication types

  • Case Reports

MeSH terms

  • Abscess / microbiology*
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Antitubercular Agents / therapeutic use
  • Eye Infections, Bacterial / microbiology*
  • Humans
  • Male
  • Nocardia / isolation & purification*
  • Retinal Diseases / microbiology*

Substances

  • Anti-Bacterial Agents
  • Antitubercular Agents