Subretinal abscess as an initial presentation of systemic nocardiosis

Muhammad Bilal Malik, Nida Jawed Ahsan, Kiran Hilal, Syed Faisal Mahmood, M. A. Rehman Siddiqui

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We report a case of subretinal abscess as the initial presentation of systemic nocardiosis. The patient was a known case of chronic inflammatory demyelinating polyneuropathy and on long-term immunosuppressants. He presented with a rapidly progressive, unilateral decline in visual acuity in the right eye. Dilated fundus examination showed a large whitish subretinal lesion. A working diagnosis of subretinal abscess was made. The appearance was highly suspicious for Nocardia abscess. On further direct questioning, it was noted that the patient had been experiencing low-grade fever and non-productive cough for 1 month. The patient was referred to infectious diseases for systemic work-up and a vitreous tap was done, along with intravitreal antibiotics. Blood culture and bronchoalveolar lavage both reported Nocardia species. Sensitivity-guided antibiotic therapy resulted in improved systemic condition and a quiet and comfortable right eye, but vision could not be saved due to late presentation.

Original languageEnglish
Article numbere236898
JournalBMJ Case Reports
Issue number11
Publication statusPublished - 2 Nov 2020


  • drugs: infectious diseases
  • eye
  • infection (neurology)
  • radiology
  • retina


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