Purpose. To describe a case of postoperative
scleritis caused by a novel strain of Nocardia resistant to
linezolid and
trimethoprim-sulfamethoxazole (
TMP-SMX). Methods. Case report of a patient with microbiologically proven
scleritis due to Nocardia asteroides. Results. The patient presented with
pain, redness, and nodules on the sclera three months following
pterygium excision with
mitomycin C and amniotic membrane placement. As no response was noted with empiric treatment for bacterial
scleritis,
debridement was performed. The cytopathology report showed gram positive filamentous bacteria. A presumptive diagnosis of Nocardia
scleritis was made and
therapy was initiated based on a literature review on treatments for
Nocardia infections. Cultures returned growing Nocardia asteroides.
Antibiotic sensitivity testing revealed resistance to
linezolid and
TMP-SMX which are the traditional drugs of choice for Nocardia. The patient was treated with
amikacin and
imipenem as well as extensive
debridement with pedicle grafts. The patient's
scleritis resolved with a good visual outcome. Conclusions. Cultures should be obtained in all cases of
necrotizing scleritis in patients with a recent history of conjunctival surgery to rule out unusual organisms such as Nocardia. Although literature states that resistance to
linezolid and
TMP-SMX is rare in Nocardia, sensitivity testing can be useful in unresponsive cases.