Abdelmegid Omar, Thakur Shambhawi, Cheung Albert Y
University of Massachusetts Medical School, Department of Ophthalmology, Worcester, MA, USA.
Eastern Virginia Medical School, Department of Ophthalmology, Norfolk, VA, USA.
Am J Ophthalmol Case Rep. 2023 Jan 12;29:101794. doi: 10.1016/j.ajoc.2023.101794. eCollection 2023 Mar.
This report describes a case and management of a 69-year-old female with infectious scleritis found to be caused by species.
Our patient presented with severe constant pain in the left eye (OS) following cataract surgery. She had a pertinent past medical history significant for renal transplantation (on oral tacrolimus, mycophenolate, and prednisone). Slit lamp examination OS (1 month after cataract surgery) demonstrated 3+ injection temporally accompanied by scleral thickening and multiloculated abscesses with purulent drainage from small conjunctival erosions. The abscesses were debrided and sent for gram stain and culture. The patient was treated with repeated subconjunctival injections of antibiotics and an antifungal; topical amphotericin, vancomycin, and amikacin; and oral trimethoprim-sulfamethoxazole (double strength). Two separate gram stains with cultures confirmed the diagnosis and species identification. The patient responded well to repeat subconjunctival injections early on in addition to the prescribed regimen, remaining free of disease at the last follow-up (12 months following presentation).
This unique case demonstrates infectious scleritis caused by an uncommon Nocardia species () that was successfully treated with similar strategies used for other reported Nocardia species. As Nocardia scleritis can lead to adverse outcomes if not treated promptly and properly, it should be considered on the differential diagnoses in an immunocompromised patient who presents with acute ocular symptoms after any recent ocular surgery.
本报告描述了一例69岁女性感染性巩膜炎的病例及治疗情况，该感染性巩膜炎被发现由[具体菌种]引起。
我们的患者在白内障手术后左眼出现严重的持续性疼痛。她有重要的既往病史，因肾移植（正在服用口服他克莫司、霉酚酸酯和泼尼松）而具有显著意义。裂隙灯检查左眼（白内障手术后1个月）显示颞侧3+充血，伴有巩膜增厚和多房性脓肿，并有来自小结膜糜烂的脓性引流。脓肿被清创并送去进行革兰氏染色和培养。患者接受了反复的结膜下抗生素和抗真菌药物注射治疗；局部使用两性霉素、万古霉素和阿米卡星；以及口服复方新诺明（双倍剂量）。两次单独的革兰氏染色及培养证实了诊断并鉴定了菌种。患者除了规定的治疗方案外，早期对反复的结膜下注射反应良好，在最后一次随访（就诊后12个月）时仍无疾病。
这个独特的病例显示了由一种不常见的诺卡氏菌属菌种（[具体菌种]）引起的感染性巩膜炎，采用与其他已报道的诺卡氏菌属菌种相似的策略成功治愈。由于诺卡氏菌性巩膜炎如果不及时恰当治疗可能导致不良后果，对于任何近期眼部手术后出现急性眼部症状的免疫受损患者，在鉴别诊断时应考虑到该病。
