RESUMO
Nocardia is a rare opportunistic pathogen that primarily affects the skin, lungs, and central nervous system. Intraocular infection caused by Nocardia species is a rare event in individuals who are immunocompetent. We herein present a case of a female individual who is immunocompetent, with a left eye injury caused by a contaminated nail. Unfortunately, this exposure history was not recognized at the initial visit, which led to a delay in diagnosis and the eventual development of intraocular infections with multiple hospital admissions in a short period of patients. A definitive diagnosis of Nocardia brasiliensis by matrix-assisted laser desorption ionization-time of flight mass spectrometry. With the original intention of reporting the case, we hope that physicians should be aware of rare pathogen infections, especially when conventional antibiotic therapy is ineffective, to avoid untimely treatment and poor prognosis. Furthermore, matrix-assisted laser desorption ionization-time of flight mass spectrometry or next-generation sequencing should be considered as new techniques for identifying pathogens.
Assuntos
Nocardiose , Nocardia , Humanos , Feminino , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Nocardiose/diagnóstico , Nocardiose/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
PURPOSE: To report a case with unilateral preexisting ocular toxoplasmosis (OT) and newly occurred active retinochoroidal inflammation associated with white-centered retinal hemorrhages (Roth spots) in the healthy eye. DESIGN: Case report. METHODS: A 20 year-old man presented with a decrease of visual acuity in his right eye associated with 2+ cells in the anterior chamber. Ophthalmoscopy revealed an active retinochoroidal lesion on the upper nasal border of the optic disc associated with local hemorrhage and vitritis. The posterior pole presented white-centered flame-shaped retinal hemorrhages. RESULTS: Toxoplasmosis serology showed an IgG titer >300IU/ml and a negative IgM titer. A complete blood count revealed no abnormalities; other serologies were negative. After 2 weeks of treatment with sulfadiazine, pyrimethamine, folinic acid and prednisone, although the peripapillary lesion was still active, the Roth spots disappeared. CONCLUSION: OT may be one differential diagnosis of patients suffering Roth spots in association with retinochoroidal inflammation.