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Case report
Subretinal abscess as an initial presentation of systemic nocardiosis
  1. Muhammad Bilal Malik1,
  2. Nida Jawed Ahsan1,
  3. Kiran Hilal2,
  4. Syed Faisal Mahmood3 and
  5. M A Rehman Siddiqui1
  1. 1Section of Ophthalmology, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
  2. 2Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
  3. 3Section of Infectious Diseases, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
  1. Correspondence to Dr M A Rehman Siddiqui; rehman.siddiqui{at}gmail.com

Abstract

We report a case of subretinal abscess as the initial presentation of systemic nocardiosis. The patient was a known case of chronic inflammatory demyelinating polyneuropathy and on long-term immunosuppressants. He presented with a rapidly progressive, unilateral decline in visual acuity in the right eye. Dilated fundus examination showed a large whitish subretinal lesion. A working diagnosis of subretinal abscess was made. The appearance was highly suspicious for Nocardia abscess. On further direct questioning, it was noted that the patient had been experiencing low-grade fever and non-productive cough for 1 month. The patient was referred to infectious diseases for systemic work-up and a vitreous tap was done, along with intravitreal antibiotics. Blood culture and bronchoalveolar lavage both reported Nocardia species. Sensitivity-guided antibiotic therapy resulted in improved systemic condition and a quiet and comfortable right eye, but vision could not be saved due to late presentation.

  • retina
  • infection (neurology)
  • eye
  • drugs: infectious diseases
  • radiology

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Footnotes

  • Contributors MARS and SF Mahmood conceived the idea. MARS and NJA wrote the initial draft. NJA and MBM acquired and analysed the data. MBM and KH made multiple revisions to the draft. KH provided intellectual content to the radiological aspect. SFM provided intellectual content to the infectious disease aspect. All authors reviewed the final draft and approved it.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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