Case History1

A 56-year old man vacationing in Florida went to an emergency room to seek treatment for his left eyelid which had been inflamed for four days. He was referred to an infectious disease specialist who prescribed oral cefuroxime. The swelling continued over the next two days. He also developed swelling and erythema on the left side of his face and neck. He decided to return home to Canada for treatment.

After returning home, the attending physician noted edema and erythema of the left periorbital area. A small superficial ulcer was observed on the left-upper lid. The conjunctiva had multiple non-ulcerative nodules and a purulent discharge. Tender preauricular and submandibular adenopathy was also noted. The patient

denied any change in vision and no other symptoms were observed.

Questioning revealed that he had no exposure to animals. The patient did recall that three days prior to his illness he had rubbed his eyes while planting shrubs. The patient was started on IV cephazolin and gentamicin eye drops. He rapidly improved and was released on oral cephalexin five days later.

A gram stain of the discharge showed branching gram-positive rods. An eye swab grew white, dry colonies, which were later confirmed as Nocardia brasiliensis. “This organism is a common soil inhabitant in subtropical and tropical climates and has been found as far north as North Carolina.”

The patient had apparently inoculated his eye while gardening. Contaminated gloves can be a microbial hazard.

1Gardam M et al. Case report: An eye for horticulture. Lancet 1998; 351:876.

DEPARTMENT OF FAMILY MEDICINE – DIVISION OF PUBLIC HEALTH AND PUBLIC SERVICE

MEDICAL UNIVERSITY OF SOUTH CAROLINA, 171 ASHLEY AVENUE, CHARLESTON, SC 29425-2217