title: Nocardia exalbida blebitis: a case report.
abstract: OBJECTIVE
  To report the first documented case of Nocardia exalbida blebitis.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: *Department of Ophthalmology †Infectious Diseases Section, Tulane School of Medicine, Tulane University, New Orleans, LA.
authors.forename: Cristos
authors.initials: C
authors.lastname: Ifantides
authors.forename: Oscar R
authors.initials: OR
authors.lastname: Batlle
authors.forename: David
authors.initials: D
authors.lastname: Mushatt
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Ayyala
mesh_terms: D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009615:Nocardia / Q000302:isolation & purification*; D009617:Nocardia Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D019651:Plastic Surgery Procedures; D054047:Surgical Stomas; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D041623:Tomography, Optical Coherence; D014130:Trabeculectomy / Q000009:adverse effects; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin