Early Diagnosis of Nocardia asteroides Endophthalmitis by Retinal Biopsy: Case Report and Review

Hematogenous nocardial endophthalmitis is a rare but devastating infection. Of a total of 10 cases (one described for the first time and nine reported previously in the English-language literature), the lung appeared to be the primary focus of infection in eight (80%). Six (60%) of the cases occurred in individuals receiving corticosteroid therapy; these individuals had undergone renal transplantation (two cases) or cardiac transplantation (one case) and had underlying conditions that included lymphoma (two cases) and chronic active hepatitis (one case). In two immunocompetent individuals, infection followed dissemination from traumatic wounds. Common clinical findings were a rapid decrease in visual acuity and eye pain. All nine of the previously reported cases resulted in total blindness of the involved eye; five patients died not long after diagnosis. In the present report (the first in a cardiac transplant recipient), a favorable outcome with restoration of vision followed early diagnosis through the recently developed technique of fine-needle retinal biopsy.