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 <i>Nocardia farcinica</i>. 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 <i>N. farcinica</i>, 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, <i>Nocardia</i> species, particularly the more resistant <i>N. farcinica</i>, 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.