PMC7849851_01
Left eye showing lid edema, diffuse conjunctival congestion and a scleral abscess at the temporal limbus. Cornea appears hazy and anterior chamber is full of blood stained fibrinous exudates
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F1
Anterior chamber was filled with blood tinged fibrinous exudates and a scleral abscess was noted at the infero-temporal limbus [Figure 1].
(a-c): On modified Ziehl-Neelsen stain (a), Nocardia appears as partially acid fast beaded branching filamentous bacilli. Gram stain showing mildly Gram positive beaded filaments indicating Nocardia. On Chocolate Agar (b), colonies of Nocardia appear as white powdery growth which was seen after a period of 3 days
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F2
On Gram stains, mildly Gram-positive beaded filaments more prominent in the modified Ziehl-Neelsen stain with 1% sulphuric acid were noted [Figure 2a and b]. Chalky white colonies grew on the Chocolate agar 3 days after inoculation [Figure 2c].
(a and b): CT scan orbit, Axial view (a) depicting gross proptosis with preseptal soft tissue edema along with thickening of the sclera and the choroid in the left globe. Multiple membrane-like hyperdense septae are seen in the posterior vitreous cavity suggestive of multiple abscess formation along with a ring enhancing lesion on contrast enhancement is seen in the intraconal space just posterior to the globe. Sagittal section (b) passing through the left globe demonstrates the hyperdense membrane like septae in the mid and the posterior vitreous
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F3
On IV contrast, there was a ring enhancing lesion in the intraconal space just behind the globe suggestive of an intraconal abscess [Figure 3a and b].