Nocardia asteroides subretinal abscess in patient with acute myelogenous leukemia after allogeneic stem cell transplant.
OBJECTIVE
Nocardia asteroides is the most common bacterial cause of subretinal abscesses; however, the diagnosis is often delayed because of the lack of suspicion leading to poor visual prognosis and possible enucleation.


METHODS
A 40-year-old man with a history of allogeneic stem cell transplant presents with decreased vision and a macular subretinal abscess.


RESULTS
Examination revealed decreased vision at 20/100 with a peripapillary creamy subretinal lesion extending to the nasal margin of the fovea associated with intraretinal and subretinal hemorrhages without vitritis. Workup revealed disseminated N. asteroides, confirmed with a skin biopsy with the involvement of skin, eyes, lungs, and brain. Intravitreal amikacin and vancomycin were promptly given along with systemic vancomycin, sulfamethoxazole/trimethoprim, and meropenem. Vision improved rapidly to 20/40 with stabilization and eventual scarring of the lesion.


CONCLUSIONS
This case illustrates that rapid diagnosis and treatment of subretinal N. asteroides can possibly have a good visual outcome and stabilization of the ocular manifestations.
Department of Ophthalmology, University Hospitals Case Medical Center, Cleveland, Ohio.
Marina A
MA
Eisenberg
Shawn C
SC
Wilker
D000038:Abscess / Q000382:microbiology*; D000328:Adult; D016026:Bone Marrow Transplantation; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D009617:Nocardia Infections / Q000175:diagnosis*; D009616:Nocardia asteroides / Q000302:isolation & purification*; D012164:Retinal Diseases / Q000382:microbiology*