Endogenous Nocardia farcinica Endophthalmitis in Chronic Lymphocytic Leukemia: A Case Report and Literature Review.

PURPOSE: The aim of this study was to describe a case of endogenous endophthalmitis secondary to Nocardia farcinica and summarize the presentation, management, and prognosis of Nocardia eye infections.

METHODS

This was an observational case report and literature review.

RESULTS

A 64-year-old man with a history of chronic lymphocytic leukemia (CLL) presented for three weeks of headache and acute slurred speech. During his admission, he developed decreased vision, floaters, and pain in his left eye, and was found to have a large subretinal infiltrate with overlying vitritis. His endophthalmitis was later determined to be secondary to Nocardia farcinica dissemination based on microbiologic testing. Despite successful systemic nocardial treatment and intravitreal antibiotics, he developed a blind painful eye, and he was offered enucleation.

CONCLUSION

Nocardia species are rare causes of endogenous endophthalmitis that usually occur in immunosuppressed patients. Delayed diagnosis and resistance to first line empiric intravitreal antibiotics contribute to a poor visual prognosis.