Ifantides Cristos, Batlle Oscar R, Mushatt David, Ayyala Ramesh S
*Department of Ophthalmology †Infectious Diseases Section, Tulane School of Medicine, Tulane University, New Orleans, LA.
J Glaucoma. 2015 Apr-May;24(4):e19-21. doi: 10.1097/IJG.0b013e3182a07574.
To report the first documented case of Nocardia exalbida blebitis.
A 57-year-old immunocompetent African American man with a long-standing history of open-angle glaucoma in both eyes treated with trabeculectomy presented with a diffusely hyperemic, thin, cystic, leaky bleb with no discharge in his left eye. The patient underwent bleb revision using an amniotic membrane patch graft followed by 1 month of antibiotics. He presented second time with an inflamed eye and brisk leakage and underwent a second bleb revision. His cultures remained negative. Two months after this second surgery, an anterior staphyloma had formed within the bleb area, and visible leakage of purulent material and a dense hypopyon was noted. Gram stain of the material showed rare long-branching rods. The material was sent to an outside laboratory for culture and identification.
All 6 cultures were positive for N. abscessus complex and N. exalbida. The patient underwent 6 months of Bactrim therapy with topical sulfonamide and amikacin, leading to the disappearance of the hypopyon and an inflammation-free eye.
N. exalbida is a newly identified Nocardia species that must be considered as a possible infectious agent in immunocompetent patients with blebitis refractive to initial topical antibiotic therapy. Delay in diagnosis and initiation of appropriate antibiotic regimen can result in an aggressive inflammatory process and vision loss.
报告首例有记录的浅黄诺卡菌性巩膜瓣炎病例。
一名57岁免疫功能正常的非裔美国男性，双眼患有开角型青光眼且长期接受小梁切除术治疗，其左眼出现弥漫性充血、薄、囊性、渗漏的巩膜瓣，无分泌物。患者接受了羊膜贴片移植的巩膜瓣修复术，随后使用了1个月的抗生素。他第二次因眼睛发炎和明显渗漏前来就诊，并接受了第二次巩膜瓣修复术。其培养结果仍为阴性。第二次手术后两个月，在巩膜瓣区域形成了一个前葡萄肿，观察到有脓性物质明显渗漏和浓密的前房积脓。该物质的革兰氏染色显示有罕见的长分支杆菌。该物质被送往外部实验室进行培养和鉴定。
所有6次培养均显示脓肿诺卡菌复合群和浅黄诺卡菌呈阳性。患者接受了6个月的复方新诺明治疗，局部使用磺胺类药物和阿米卡星，导致前房积脓消失，眼睛无炎症。
浅黄诺卡菌是一种新发现的诺卡菌属菌种，对于初始局部抗生素治疗无效的免疫功能正常的巩膜瓣炎患者，必须将其视为可能的感染病原体。诊断延迟和启动适当的抗生素治疗方案可能导致炎症进程加剧和视力丧失。
