A woman in her 60s with known human leukocyte antigen B27 positivity was referred for protracted intraocular inflammation and intractable pain 5 months after trabeculectomy in the right eye. On presentation, best-corrected visual acuity was 20/100. Ultrasonographic imaging showed moderate vitritis, and slitlamp examination mirrored this (Figure, A).
Anterior chamber aspirates, which required a vitrector to extract, demonstrated filamentous, acid-fast, gram-positive nocardia (Figure, B). Despite aggressive treatment with intravitreal amikacin/vancomycin and oral cotrimoxazole, guided by culture and sensitivity analyses, the eye was ultimately enucleated.