Bilateral Nocardia farcinica Chorioretinitis With Endogenous Endophthalmitis and Concurrent CNS Disease: A Case Report

Disseminated nocardiosis with endogenous endophthalmitis is a rare but life-threatening condition associated with significant morbidity and risk of permanent vision loss. We report a fatal case of bilateral chorioretinitis with unilateral endogenous endophthalmitis accompanied by soft tissue and central nervous system involvement caused by Nocardia farcinica. An 86-year-old woman presented with a five-day history of a progressively worsening blind spot in the left eye, and ophthalmic examination revealed bilateral chorioretinal lesions with marked anterior chamber and vitreous inflammation in the left eye. Soft tissue cultures grew N. farcinica, and subsequent imaging identified additional infectious foci in the lungs as well as the frontal and parietal lobes of the brain. Although an uncommon cause of endogenous endophthalmitis, Nocardia species, particularly the more resistant N. farcinica, should be considered in the differential diagnosis of intraocular infections, especially in immunocompromised patients, as bilateral ocular involvement and concomitant cerebral disease can pose substantial diagnostic and therapeutic challenges.