Double trouble: Concurrent anterior and posterior scleritis due to staphylococcus hominis and nocardia infection following a cow tail injury

A 42-year-old female presented with severe redness, eye pain, and watering in the left eye following an injury caused by a cow’s tail one month prior. Examination of the right eye was unremarkable. Slit-lamp examination of the left eye revealed a large scleral abscess with multiple pus points located in the nasal quadrant, leading to dellen formation on the cornea. Fundus examination of the left eye revealed inferonasal retinal detachment with subretinal fluid. Ultrasound B-scan of the left eye showed retinal detachment with shifting fluid, along with diffuse thickening of the outer coat. Culture from the scleral biopsy revealed methicillin-resistant Staphylococcus hominis and Nocardia asteroides , both of which were sensitive to amikacin. The patient was started on fortified amikacin and an oral sulfamethoxazole-trimethoprim combination. Response to treatment was good, so the decision to add oral steroids was deferred. At the 1-month follow-up, the left eye showed a healed ulcer with a conjunctivalized surface, and fundus examination revealed complete resolution of the exudative retinal detachment. It is essential to obtain a thorough medical history before initiating treatment for scleritis, and co-infection with two organisms necessitates early and effective aggressive antimicrobial therapy, depending on the susceptibility. Corticosteroids are not always necessary for managing posterior scleritis associated with infective scleritis.