Endogenous Nocardial Endophthalmitis Misdiagnosed as Giant Cell Arteritis

Abstract

Steven Gagnon,1– 3 Marc Saab1,2,4– 6 1Département d’ophtalmologie et d’oto-rhino-laryngologie – chirurgie cervico-faciale, Université Laval, Québec, QC, Canada; 2Hôpital Régional de Rimouski, Centre intégré de santé et de services sociaux du Bas-Saint-Laurent, Rimouski, QC, Canada; 3Centre Universitaire d’ophtalmologie (CUO), Hôpital du Saint-Sacrement, Québec, QC, Canada; 4Hôpital Charles-LeMoyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, Greenfield Park, QC, Canada; 5Service d’ophtalmologie, Université de Sherbrooke, Sherbrooke, QC, Canada; 6Département d’ophtalmologie, Université de Montréal, Montréal, QC, CanadaCorrespondence: Steven Gagnon 1083, rue du Chevreau, Lévis, QC G6Z 3C3, CanadaEmail [email protected]: Endogenous endophthalmitis is uncommon but potentially dangerous. We present a fatal presentation of endogenous Nocardial endophthalmitis in the context of steroid use for treatment of giant cell arteritis.Case Presentation: An 84-year-old Caucasian female presented to the local emergency room with severe headaches, myalgia and shoulder and calf muscle pain. She was treated for a presumed diagnosis of giant-cell arteritis with corticosteroids and subsequently developed an intense retro-orbital pain in the right eye. Fundus examination revealed a white, vascularized chorioretinal mass at the equator of the eye in the inferotemporal quadrant. Antibiotics were given and a vitrectomy was performed. The culture of the vitreous showed Nocardia nova and a diagnosis of disseminated Nocardiosis was made.Conclusion and Significance: Although uncommon, it is important that ophthalmologists are aware of Nocardial infections as a differential diagnosis of retinal mass, particularly in immunocompromised patients.Keywords: Nocardiosis, systemic, Nocardia, eye, intraocular, endophthalmitis, endogenous

Keywords

• nocardiosis
• systemic
• nocardia
• eye
• intraocular
• endophthalmitis
• endogenous