A case of scleritis due to Nocardia elegans with diagnostic difficulties Katsuya Yagisawa 1 , Ayako Tawada 1 , Kanako Suzuki 2 , Jiro Yotsukura 1,3 , Shuichi Yamamoto 1 1Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine 2Department of Ophthalmology, Japanese Red Cross Narita Hospital 3Kakisu Eye Clinic pp.847-852
Published Date 2020/7/15
DOI https://doi.org/10.11477/mf.1410213613
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Abstract Purpose:To report a case of scleritis due to Nocardia elegans that posed diagnostic difficulties.

Case:A 82-year-old female was referred to us for scleritis. She had been diagnosed as branch retinal vein occlusion with macular edema in the left eye 10 weeks before. She had been treated with subtenon injection of triamcinolone acetonide. She had been diagnosed with scleritis after 6 weeks of treatment. She had been receiving topical instillation of antibiotics since then.

Finding and Clinical Course:Corrected visual acuity was 1.0 right and 0.06. The left eye showed hyperemia, nodular lesions following scleral necrosis, and cells in the anterior chamber. The findings improved after topical and systemic treatments with antibiotics and corticosteroid. The ocular lesions recurred 11 weeks later. Nodular conjunctival lesions became necrotic. Nocardia elegans was cultured from the nodular lesion. Treatment with sulfamethoxazole-trimethoprim was followed by rapid improvement.

Conclusion:This case illustrates that infection by Nocardia elegans may develop following routine treatment of scleritis including subtenon injection of triamcinolone pacetonide.

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