Castle George, Heath Gregory
York General Hospital, Ophthalmology Department, York, United Kingdom.
GMS Ophthalmol Cases. 2021 May 17;11:Doc10. doi: 10.3205/oc000183. eCollection 2021.
Nocardiosis is an extremely rare, opportunistic, Gram-positive bacterial infection that has a high mortality rate in those patients who are immunocompromised in the presence of disseminated disease. We describe a case of an elderly lady being treated with high-dose corticosteroids for giant cell arteritis that presented with ischaemic optic atrophy. Subsequent deterioration was accompanied by the development of subretinal lesions. Further extensive evaluation discovered she had pulmonary nocardiosis with widespread dissemination. The case has several learning points, in particular: Subretinal abscesses maybe a harbinger of serious hitherto undiagnosed infection which portend a poor prognosis.Vital signs in the immunocompromised may appear to be normal in the presence of serious infection.
诺卡菌病是一种极其罕见的机会性革兰氏阳性细菌感染，在患有播散性疾病且免疫功能低下的患者中死亡率很高。我们描述了一例老年女性患者，她因巨细胞动脉炎接受大剂量皮质类固醇治疗，出现了缺血性视神经萎缩。随后病情恶化，并伴有视网膜下病变的发展。进一步的全面评估发现她患有肺诺卡菌病并广泛播散。该病例有几个值得学习的要点，特别是：视网膜下脓肿可能是严重的、迄今未被诊断的感染的先兆，预示着预后不良。在严重感染的情况下，免疫功能低下患者的生命体征可能看起来正常。
