Subretinal Abscess Research Articles

SUBTENON'S VANCOMYCIN INJECTION FOR SUBRETINAL ABSCESS SECONDARY TO METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS ENDOGENOUS ENDOPHTHALMITIS: A CASE REPORT AND LITERATURE REVIEW.

To report the use of a subtenon's vancomycin injection for the treatment of subretinal abscess secondary to methicillin-resistant Staphylococcus aureus endogenous endophthalmitis. A 17-year-old man developed endogenous endophthalmitis with subretinal abscess in his right eye secondary to methicillin-resistant Staphylococcus aureus bacteremia from axillary necrotizing fasciitis. Despite prompt treatment with IV vancomycin and an intravitreal vancomycin injection, the patient displayed minimal improvement. The patient was subsequently treated with a subtenon's vancomycin injection. The injection technique is described in detail, as well as a review of the treatment options available for bacterial subretinal abscesses. On presentation, examination revealed minimal vitritis and a large yellow subretinal abscess superotemporally extending close to the macula with subretinal fluid inferotemporally involving the macula. Four days postintravitreal vancomycin injection, the abscess remained stable and the patient developed an exudative detachment temporally. Vancomycin was injected superotemporally in the subtenon's space with no complications during the procedure or during his postoperative recovery. At seven days postinjection, the subretinal abscess and exudative retinal detachment resolved completely with necrosis at the area of previous abscess. We present the first successful case of subtenon's vancomycin injection for the treatment of bacterial subretinal abscess. Our case demonstrates that subtenon's injection of antibiotics is a safe and effective nonsurgical management option for bacterial subretinal abscesses.

Nocardia paucivorans Endophthalmitis and Cerebral Abscesses in an Immunocompetent Patient

Abstract Nocardia spp are an uncommon cause of central nervous system infections and particularly endophthalmitis. In this case report, we present the first documented case of endogenous Nocardia paucivorans endophthalmitis and subretinal abscesses. We also provide a brief summary of the literature regarding ocular and cerebral nocardiosis. Early diagnosis and management improve outcomes; hence, clinicians should be cognizant of Nocardia infection as a differential diagnosis in cases of cerebral abscess or endophthalmitis, including in the immunocompetent.

Disseminated nocardiosis in a patient with alcoholic liver cirrhosis: a case report

BackgroundNocardia are Gram-positive, aerobic, filamentous bacteria that can cause localized or disseminated infections. Immunocompromised patients are at a higher risk of developing Nocardia infection and further dissemination of the disease. To date, limited data have documented the relationship between nocardiosis and alcoholic liver disease.Case presentationWe report the case of a 47-year-old man with a known history of alcoholic liver cirrhosis. The patient presented to our emergency department with redness, swelling in the left eye, and diminished bilateral vision. Fundus examination of the left eye was obscured, while that of the right eye was consistent with subretinal abscess. Therefore, endogenous endophthalmitis was suspected. Imaging revealed two ring-enhancing lesions in the brain, and multiple bilateral small cystic and cavitary lung lesions. Unfortunately, the left eye eventually eviscerated due to the rapid progression of the disease. Cultures from the left eye were positive for Nocardia farcinica. The patient was started on imipenem, trimethoprim/sulfamethoxazole, and amikacin based on culture sensitivity. The patient’s hospitalization course was complicated by his aggressive and advanced condition, which led to his death.ConclusionsAlthough the patient’s condition initially improved with the recommended antibiotic regimens, it led to death owing to the patient’s advanced condition. Early detection of nocardial infection in patients with typical or atypical immunosuppressive conditions may improve overall mortality and morbidity. Liver cirrhosis disrupts cell-mediated immunity and may increase the risk of Nocardia infection.

Klebsiella pneumoniae Endophthalmitis with Subretinal Abscess: A Case Series and Review of the Literature

ABSTRACT This study assessed prognostic factors and the role of vitrectomy in patients with subretinal abscesses secondary to K. pneumoniae endophthalmitis. We reviewed published studies, including three cases from our cohort. Among 50 eyes, 26 had poor visual outcomes (final visual acuity <20/800, eyeball removal, or phthisis bulbi). Poor outcomes correlated with delayed ocular symptom-to-diagnosis time, initial visual acuity <20/800, severe vitritis, and macular involvement of abscesses (p < 0.001, p = 0.008, p < 0.001, and p = 0.033, respectively). Vitrectomy had a trend towards reducing eyeball removal and phthisis bulbi rates compared with non-vitrectomy (10.8% vs 30.8%, p = 0.181). However, the final visual acuity was not different and the rate of retinal detachment tended to be higher in vitrectomized eyes (45.9% vs 15.4%, p = 0.095). The study suggested that vitrectomy and drainage of K. pneumoniae subretinal abscesses could be avoided in patients with a mild degree of vitritis.

Subretinal Abscess Complicated by Post-infectious Retinal Vasculitis Following Strabismus Surgery.

An 8-year-old girl presented with a subretinal abscess after strabismus surgery. This was treated successfully with medial rectus suture removal, pars plana vitrectomy, intravitreal antibiotics, and intravenous antibiotics. Recovery was complicated by acute post-infectious retinal vasculitis after tapering high-dose corticosteroids, requiring an extended corticosteroid regimen over 2 months until resolution. [J Pediatr Ophthalmol Strabismus. 2023;60(3):e26-e30.].

Subretinal and Liver Abscesses in Klebsiella Endophthalmitis

A 40-year-old Hispanic male presented to the ophthalmology emergency department with 1-day of blurred vision in his left eye. He reported fevers the week prior. Examination of the left eye (A) was remarkable for a subretinal abscess with hemorrhage, vasculitis, and a preretinal hypopyon. A vitreous sample was taken, and intravitreal antibiotics were administered in the left eye. He was admitted for a systemic work-up of endogenous endophthalmitis. Blood cultures were positive for Klebsiella pneumoniae. CT scan of the abdomen (B) demonstrated a 7.3×4.5×4.5 cm hypoattenuating lesion with septations in the right lobe of the liver. Klebsiella endophthalmitis is most commonly seen in Asia and has poor visual outcomes when associated with an endogenous source. Diagnosis should prompt abdominal imaging as liver abscesses are associated. The patient was treated with IV antibiotics and the liver abscess was drained by interventional radiology (Fig. 1).

The First Case of the Subretinal Abscess After Sars-CoV2 Infection

Ever since the new coronavirus has become the cause of the COVID-19 pandemic; it has manifested with unknown and new presentations. In this report, we are presenting a 46-year-old female infected with COVID-19 (confirmed by Reverse transcription polymerase chain reaction (RT-PCR) nasal swab test) and a known case of Diabetes mellitus type 2 who had a history of Intensive care units (ICU)admission due to COVID-19 with uncontrolled diabetes mellitus. In the second admission after recovery, she had blurred vision. Fundus examination revealed multiple yellow-white well-demarcated nonpigmented masses. Diagnosis of the multiple subretinal abscesses was confirmed. KOH-Calcofluor staining of vitreous fluid was negative for fungal infections of the eye. No polymorphonuclear leukocytes (PMN), epithelial cells, nor any organisms were detected. The patient was treated with an injection of the intravitreal Amphotericin B 10 µg/0.1 cc. To our knowledge, the presented case is the first case of the subretinal abscess after COVID-19 infection.

DISSEMINATED ACTINOMYCETOSIS WITH PNEUMONIA, LEFT GLUTEAL, LEFT EYE, AND BRAIN ABSCESSES IN A PATIENT WITH SJÖGREN AND INTERSTITIAL LUNG DISEASE

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: A localized or disseminated infection by an aerobic gram-positive beaded filamentous branching actinomycete Nocardia is called Nocardiosis. Its presence is ubiquitous, causing infection in immunosuppressed and healthy individuals. An increased incidence is due to the greater use of immunosuppressants and improved diagnostic processes. On average, 500-1,000 new cases occur in USA [1] CASE PRESENTATION: 86-year-old female with hypertension, diabetes, Sjogren's, and interstitial lung disease (ILD) on 10 mg prednisone came to the eye clinic for left blurry eye pain for three days. A recent ILD flare was treated with a steroid burst. Eye exam showed acute left eye endophthalmitis with bilateral chorioretinal infiltrates (Figure A1-2). A white cell count was normal with neutrophilia and an absolute lymphocyte count of 903 cells/mm3. Human immunodeficiency virus, syphilis, endemic fungal, and Quantiferon testing and blood cultures were negative. Echocardiogram was normal, while prednisone was held. Computed tomography (CT) of the chest, abdomen, and pelvis revealed interstitial pneumonia, new left lower lobe consolidation, left gluteal and right paraspinal muscle abscess, and left gluteal biopsy showed acid-fast filamentous microorganisms with culture positive for Nocardia farcinica resistant to ceftriaxone, clarithromycin, and tobramycin (Figure B1-4). Magnetic resonance imaging (MRI) brain revealed multiple ring-enhancing lesions in the right midbrain, left cingulate gyrus, parietofrontal and temporal lobe (Figure C1-3). On the 14th day, the left eye revealed a small subretinal abscess. An initial regimen of meropenem and bactrim was changed to amikacin and imipenem for six weeks at discharge. A week later, she was back in intensive care in a comatose state with worse MRI brain changes and placed on comfort care DISCUSSION: Disseminated disease is common in males and often presents with brain lesions, with N. farcinica being the frequent subspecies causing it due to its predilection for brain and skin tissue with an increased mortality rate [2-4]. N. farcinica is resistant to multiple antibiotics, including third-generation cephalosporins. A frequent site of the abscess is the parietofrontal lobe [5]. Mortality in multiple abscesses is higher than with a solitary abscess (66% vs. 33%) [6]. Inappropriate empirical therapy has higher mortality at 31% than an appropriate therapy (10%) [7]. Concomitant involvement of lungs, brain, eye, and muscles is rare. Due to a lower incidence, it is not considered at initial diagnosis CONCLUSIONS: In chronic respiratory disease patients on low-dose steroids, the onset of new visual or nervous system symptoms is a concern for disseminated nocardiosis with a recent history of steroid burst, lymphopenia, and neutrophilia REFERENCE #1: Beaman BL, Burnside J, Edwards B, Causey W. Nocardial infections in the United States, 1972-1974. J Infect Dis. 1976;134(3):286-9 REFERENCE #2: Kramer MR, Uttamchandani RB. The radiographic appearance of pulmonary nocardiosis associated with AIDS. Chest. 1990;98(2):382-5 REFERENCE #3: Sabuncuoğlu H, Cibali Açikgo Z Z, Caydere M, Ustün H, Semih Keskil I. Nocardia farcinica brain abscess: a case report and review of the literature. Neurocirugia (Astur). 2004;15(6):600-3 DISCLOSURES: No relevant relationships by Andres Bran, source=Web Response No relevant relationships by CARLA CARUSO, source=Web Response No relevant relationships by Paragkumar Patel, source=Web Response No relevant relationships by Tarang Patel, source=Web Response No relevant relationships by SACHIN PATIL, source=Web Response No relevant relationships by ANTONY RAWINDRARAJ, source=Web Response

Managing solitary choroidal tuberculoma in an immunocompetent patient

Aim: We describe a case of young immunocompetent 18-year-old female patient who presented with sudden painless diminution of vision in left eye with vision of 20/100 on Snellen’s chart. Retinal evaluation showed a massive solitary choroidal granuloma. A positive Mantoux test (20X20 mm) was noted. The patient was started on anti-tubercular therapy and oral steroids and showed resolution of the granuloma with subretinal fluid at macula. After 3 months of oral therapy, the persistent subretinal fluid was managed with intravitreal injection of triamcinolone acetonide(2 mg). This case highlights favorable resolution of granuloma with oral therapy and a safer efficacy of triamcinolone acetonide in treating subretinal fluid due to choroidal tuberculoma with good visual outcome. Introduction: Choroidal tuberculoma is a rare ocular form of tuberculosis (TB) and is a diagnostic and a therapeutic challenge, especially when occurring without other manifestations of the disease.1,2 Involvement of the choroid occurs by direct infection or indirect immune‐mediated hypersensitivity and is the commonest clinical manifestation of intraocular TB.3 The presentation varies from a solitary choroidal granuloma (tuberculoma) to multiple choroidal tubercles, a subretinal abscess or choroiditis. We present a case of an immunocompetent patient, who presents with massive choroidal granuloma and responded to oral antitubercular and steroid therapeutic regimen. Visual acuity improved with intravitreal triamcinolone acetonide injection which resulted in resolution of subretinal fluid after 3 months

Window to the circulatory system: Ocular manifestations of cardiovascular diseases.

The changes in the cardiovascular system are associated with ocular manifestations, often as a consequence of pathological alteration in the ocular vasculature. The ease of visualization of these retinal changes makes the eye a window to the cardiovascular system. Certain congenital cardiac defects lead to changes in the retinal vascularity due to increased tortuosity and dilatation. In adults, the arterial dissection of internal carotid and vertebral arteries present as amaurosis fugax with or without oculo-sympathetic palsy. The patients with untreated infective endocarditis present with Roth spots, retinitis, embolic retinopathy, or sub-retinal abscesses. Hypoperfusive, hypertensive, or "mixed" retinopathy is a hallmark sign in patients of untreated infective endocarditis. Giant cell arteritis can present with ischemic ocular symptoms that may precipitate in irreversible vision loss. Systemic vascular manifestations such as coronary artery disease may manifest in a wide range of symptoms from amaurosis fugax to vision loss depending upon the size and location of retinal emboli. Rare cardio-oncological pathologies such as myxomas result in vision loss secondary to central retinal artery occlusion. A high clinical suspicion in patients with history of cardiovascular diseases can help in early diagnosis and management of impending, adverse cardiovascular and cerebrovascular events. In this review, we comprehensively discuss the spectrum of cardiac and vascular diseases with ocular manifestations as well as highlight the typical ocular presentations associated with these pathologies.

Anti Tuberculosis Therapy Combined with Oral Corticosteroid and Intra Vitreal Anti-VEGF in Ocular Tuberculosis

Objective : To report a late diagnosed case of posterior uveitis tuberculosis and to create awareness to ophthalmologists for treating ocular tuberculosis as soon as possible. Case Presentation : A 17-year old woman with a complaint of decreased vision in both eyes for the past 5 days. She had a history of non-purulent cough. In the initial examination, the patient was diagnosed and treated with papil edema and chorioretinitis with sub-retinal abscess and swollen disc, but she did not show any improvement. The patient was referred to the other ophthalmologist and diagnosed with ocular and systemic tuberculosis infection with choroidal neovascularization. The infection in the macula affected and aggravated visual acuity of counting finger at 1 meters. Anti-tuberculosis, oral corticosteroid and intravitreal anti-VEGF therapy were performed. The treatment showed significant improvement toward visual outcome and retinal condition. Conclusion : Treatment with oral corticosteroid treatment along the systemic tuberculosis medication and intravitreal anti-VEGF showed good outcome on the right eye but deteriorated on the fellow eye.

Diagnostic vitrectomy: a case series in a single referral center

Abstract Objective To study the results and safety of diagnostic vitrectomy in patients with unknown etiology panuveitis. Methods A retrospective descriptive observational study was carried out in which a total of 29 patients (37 eyes) were included, who underwent a vitreous biopsy due to acute intraocular inflammatory processes. In all, demographic and clinical data were collected. We studied the specific samples extraction methods and their diagnosic processing. Results Of the 29 patients analyzed, 18 were men. Mean of age was 63.11 years old (Standard Deviation: 14.55). The most frequent initial symptom was visual acuity decrease, with mean initial visual acuity being 20/40, excluding 8 eyes that had vision lower than 20/200. 21 presented unilateral ocular involvement. Vitrectomy was performed in all of them obtaining a dry sample. Vitrectomy was performed in all of the patients obtaining a dry sample. Moreover, the following techniques were done: 5 retinal biopsies, obtaining 5 Muestra diluidas, 1 subretinal abscess aspirate and 1 aqueous humor aspirate. The most frequent processing technique that was used was cytology in 25 eyes, followed by PCR (polymerase chain reaction) in 11 eyes and culture in 10 eyes. Diagnosis was achieved in 94.5% of patients. Main diagnosis found was lymphoma, followed by toxoplasmosis. Conclusions Diagnostic vitrectomy is very important in ophthalmic inflammation identification. Different techniques for obtaining and processing can be used.

Vitrectomía diagnóstica: serie de casos en un centro de referencia

ObjectiveTo study the results and safety of diagnostic vitrectomy in patients with unknown etiology panuveitis. MethodsA retrospective descriptive observational study was carried out in which a total of 29 patients (37 eyes) were included, who underwent a vitreous biopsy due to acute intraocular inflammatory processes. In all, demographic and clinical data were collected. We studied the specific samples extraction methods and their diagnosic processing. ResultsOf the 29 patients analyzed, 18 were men. Mean of age was 63.11 years old (standard deviation: 14.55). The most frequent initial symptom was visual acuity decrease, with mean initial visual acuity being 20/40, excluding 8 eyes that had vision lower than 20/200. 21 presented unilateral ocular involvement. Vitrectomy was performed in all of them obtaining a dry sample.Vitrectomy was performed in all of the patients obtaining a dry sample. Moreover, the following techniques were done: 5 retinal biopsies, obtaining 5 muestras diluidas, 1 subretinal abscess aspirate and 1 aqueous humor aspirate. The most frequent processing technique that was used was cytology in 25 eyes, followed by PCR (polymerase chain reaction) in 11 eyes and culture in 10 eyes.Diagnosis was achieved in 94.5% of patients. Main diagnosis found was lymphoma, followed by toxoplasmosis. ConclusionsDiagnostic vitrectomy is very important in ophthalmic inflammation identification. Different techniques for obtaining and processing can be used.

Resolution of subretinal abscess from presumed Nocardia chorioretinitis with serial intravitreal amikacin

Nocardia subretinal abscess is a rare complication of nocardiosis with typically poor visual outcomes. We present a case of a large submacular abscess that responded favorably to early, frequent intravitreal amikacin along with systemic antibiotic therapy.

Culture-Proven Candida Albicans Endogenous Endophthalmitis in a Patient with Onychomycosis

ABSTRACTPurpose: To report a case of Candida albicans endogenous endophthalmitis in an immunocompetent patient with onychomycosis.Methods: Retrospective case report.Results: A 40-year-old man with onychomycosis presented with C. albicans subretinal abscess in the left eye. Systemic and intravitreal injections did not prevent further progression of the infection. The patient underwent pars plana vitrectomy. One month after surgery, the intraocular inflammation gradually subsided. However, his visual acuity stayed at counting fingers as a result of macular scarring.Conclusion: The aim of this case presentation is to emphasize that endogenous fungal endophthalmitis can be seen in an immunocompetent patient. The use of systemic steroids in the past was the main reason for the progression of the disease in this case. In these situations, when the clinical findings suggest a fungal etiology, it should keep in mind that endogenous candida endophthalmitis can be a result of fungal infections from distant sites such as the toenails and systemic steroids should not be started before definite diagnosis.

Prognostic Factors and Visual Outcomes of Pyogenic Liver Abscess-Related Endogenous Klebsiella pneumoniae Endophthalmitis: A 20-year retrospective review

Endogenous K. pneumoniae endophthalmitis (EKE) has a higher incidence among East Asians, and the most common infectious source of EKE is pyogenic liver abscess (PLA). We investigate the risk factors for poor visual outcomes in patients with PLA-related EKE. The retrospective medical records of 104 patients (120 eyes) diagnosed with PLA-related EKE between 1996 and 2015. In univariate logistic regression analysis, the risk factors for poor visual outcomes were initial visual acuity (VA) worse than counting fingers (CF) (p < 0.001), eye pain (p = 0.013), hypopyon (p = 0.003), ocular hypertension (p = 0.003), positive intraocular fluids cultures (p < 0.001), subretinal abscess (p = 0.025), unilateral involvement (p = 0.017), delayed ophthalmologic visit (p = 0.022), initially presented with ocular symptoms ahead of systemic symptoms (p < 0.001), and corneal edema (p < 0.001). Intravitreal dexamethasone reduced the requirement of enucleation or evisceration (p = 0.01). The multivariate logistic regression revealed that poor initial VA worse than CF (p = 0.004) and initially presented with ocular symptoms ahead of systemic symptoms (p = 0.007) were the significant independent factors for poor visual outcomes. Early diagnosis and prompt treatment may salvage useful vision in some eyes.

Successful treatment of endogenous endophthalmitis with extensive subretinal abscess: a case report

BackgroundEndogenous endophthalmitis could lead to a devastating outcome without a prompt and appropriate management. We report a case of advanced endogenous Klebsiella pneumoniae endophthalmitis with extensive subretinal abscess that was successfully treated with a vitrectomy.Case presentationA systemically well 61-year-old man complained of ocular pain and visual decrease in his right eye for eighteen days. Ophthalmic examination showed dense inflammation in the anterior chamber and vitreous body. Systemic investigations discovered diabetes and no specific site of systemic infection was found after hospitalization. The inflammation continued to worsen after the intravitreal antibiotic injection. Therefore, a pars plana vitrectomy combined with phacoemulsification was performed. Intraoperatively, a white elevated, fluffy mass with the overlying retinal whitening and necrosis was revealed in superior periphery. In addition to this, extensive retinal hemorrhages and five adjacent subretinal whitish masses with exudative retinal detachment were observed in the posterior pole and inferior quadrants, which were suggestive of extensive subretinal abscess with intense overlying retinal inflammation. The excision of white fluffy mass superiorly was performed without retinotomy and aspiration of extensive subretinal abscess. The polymerase chain reaction of vitreous samples was positive for Klebsiella pneumonia. Intravitreal 2 mg/0.1 ml ceftazidime were repeated. Nine days after the surgery, the inflammation significantly subsided and the retina reattached. The patient was in a stable condition at subsequent visit eight months later.ConclusionThe delay in an accurate diagnosis and treatment caused extensive subretinal abscess combined with endogenous endophthalmitis. The treatment modality of subretinal abscess is typically individualized to the patient’s presentation. If the retina overlying the abscess is not necrotic, the extensive subretinal abscess can quickly absorbed after vitrectomy, retinotomy with aspiration of the abscess should be avoided to decrease the risk of retinal detachment.

Disseminated Nocardiosis with subretinal abscess in a patient with nephrotic syndrome-a case report

BackgroundNocardia infection is uncommon in clinical practice, with most cases occuring as the result of opportunistic infection in immunocompromsed patients. Here, we report a case of disseminated nocardiosis with subretinal abscess in a patient with nephrotic syndrome, and whom is receiving immunosuppressive therapy.Case presentationA 58-year-old male presented with decreased vision in his left eye, without redness or floaters, which had persisted for three days. The patient had previously been diagnosed with membranous nephropathy, and as such, had received systemic corticosteroid therapy for four months. Further, the patient had developed pneumonia three weeks prior to this presentation. The ocular lesion appeared as a creamy-white subretinal abscess, with overlying retinal hemorrhages. Subsequent administration of three intravitreal injections of vancomycin and ceftazidime ultimately led to eradication of the intraocular infection, however, two months later, the patient developed a brain abcess. Pathogens isolated from the blood were subsequently identified as Nocardia. The patient was successfully treated via systemic administration of imipenem and trimethoprim-sulfamethoxazole.ConclusionsClinicians should be aware of the possibility of Nocardia infections within all immunocompromised patients, as well as the tendency of this infection to disseminate--particularly in the brain. The early detection of Nocardia infections and prolonged treatment of the proper antibiotics may significantly improve the prognosis of this life-threatening infection.

Sub-retinal abscess as presenting feature of endogenous Candida endophthalmitis

BackgroundSub-retinal abscess as the presenting feature in the setting of endogenous fungal endophthalmitis is extremely infrequent. Immunodeficiency states are major predisposing risk factors. To the best of our knowledge, this is the first case report of Candida sub-retinal abscess as initial presentation in an immunocompetent patient.Case presentationA 32-year old, generally fit and well, female presented to us with gradually deteriorating vision in her right eye. Visual acuity was counting fingers in the right eye and, 20/30 in the left eye. Right eye fundus examination showed a full thickness, yellowish-white foveal lesion, and significant vitreous haze. Left eye examination was normal. Upon direct questioning, the patient disclosed history of backstreet abortion 3 weeks prior to the onset of her ocular symptoms. She underwent vitreous tap and intravitreal antibiotics (amphotericin B, 5 μg/0.5 ml). Vitreous culture showed profuse growth of Candida albicans. Because her condition was progressively deteriorating, she underwent 25 g vitrectomy plus repeat intravitreal amphotericin B under general anaesthesia. Three weeks post-vitrectomy, vitreous inflammation resolved completely, and the sub-retinal abscess healed with a macular scar formation. Over a follow-up of 4 years, no recurrences were observed.ConclusionOur case highlights the importance of considering Candida albicans infection in the differential diagnosis of sub-retinal abscesses. Although immunocompromised states are traditionally identified as predisposing factors for fungal infections, fungal endogenous endophthalmitis can occur in healthy individuals as well.

Disseminated Nocardiosis with retinal abscess in a patient treated for bullous pemphigoid

PurposeTo report a case of disseminated Nocardiosis with retinal and intracranial lesions. ObservationsA 49-year-old woman immunosuppressed because of treatment given for bullous pemphigoid presented with altered mental status and multiple intracranial lesions on imaging. The patient was found to have multiple retinal lesions in both eyes, including a subretinal abscess in the right eye. The patient underwent brain biopsy, confirming Nocardia farcinica histopathologically and in culture. Conclusions and ImportanceOcular Nocardiosis is a rare disease with varying prognosis that requires prompt diagnosis to ensure appropriate medical therapy.