Successful control of scleritis caused by Nocardia farcinica: A case report

Nocardia farcinica is an opportunistic pathogen that rarely causes ocular infections. This study reviewed a case of N. farcinica-mediated scleritis involving the corneal limbus. PATIENT CONCERNS: A 56-year-old man was admitted to the Department of Keratology of Jinan Second People’s Hospital due to “a red and swollen right eye accompanied with severe pain for >1 month.” He denied any history of hypertension, diabetes, systemic immune diseases and eye surgery. DIAGNOSES: Corneal defect and scleral necrosis were observed by slit lamp. Combination of anterior segment optical coherence tomography and ophthalmic ultrasound biomicroscopy was used for diagnosis and evaluation of corneal and scleral conditions. Culture and metagenomic sequencing verified that the pathogen of scleritis was N. farcinica. INTERVENTIONS: The patient was treated by sulfacetamide sodium eye drops, oral administration of sulfamethoxazole tablets, amikacin anterior chamber flushing, scleral debridement, and allogeneic scleral transplantation. OUTCOMES: The disease was successfully controlled. LESSONS: Infectious scleritis caused by N. farcinica is extremely rare. Culture of pathogenic microorganisms remains to be the gold standard for the diagnosis of infectious eye diseases. Metagenomic sequencing shows potential promise in the diagnosis of infectious eye diseases. N. farcinica is sensitive to sulfonamides and amikacin.