Treatment of presumed Nocardia endophthalmitis and subretinal abscess with serial intravitreal amikacin injections and pars plana vitrectomy

• Type of Material: Article
• Authors: Sara L. Hojjatie, Emory University; Sherveen S. Salek, Emory University; William A. Pearce, Emory University; Jill Wells, Emory University; Steven Yeh, Emory University
• Language: English
• Date: 2020-12-01
• Publisher: Springer
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s). 2020.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12348-020-00205-3
• Title of Journal or Parent Work: Journal of Ophthalmic Inflammation and Infection
• Volume: 10
• Issue: 1
• Start Page: 14
• End Page: 14
• Grant/Funding Information: This project was supported by the National Eye Institute/ National Institutes of Health core grant P30-EY06360 (Department of Ophthalmology, Emory University School of Medicine).; This research was also supported by an unrestricted departmental grant from Research to Prevent Blindness, Inc. to the Emory Eye Center, Emory University School of Medicine; Santen, Inc., and the Bayer Global Ophthalmology Awards Program.
• Keywords: Nocardia endophthalmitis; Plana vitrectomy; Amikacin injections; Subretinal abscess; Treatment
• Research Categories: Health Sciences, Rehabilitation and Therapy; Health Sciences, Opthamology; Health Sciences, Medicine and Surgery

Abstract

A 64-year-old man with a past medical history of liver transplantation on chronic immunosuppressive therapy presented with gradual worsening of vision over 2 months in his right eye. His recent history of Aspergillus and Nocardia pneumonia with positive bronchoalveolar lavage, in concert with vitritis and subretinal abscess, were concerning for endogenous endophthalmitis. A sputum culture and transbronchial lung biopsy stains grew Nocardia farcinica although aqueous humor sampling was negative. He was treated with four serial amikacin intravitreal injections over the course of 4 weeks. Pars plana vitrectomy for worsening macular traction and subsequent cataract surgery resulted in significant clinical and anatomic improvement of vision to 20/60 and consolidation of the subretinal abscess.