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Purpose . To describe a case of postoperative scleritis caused by a novel strain of  Nocardia  resistant to linezolid and trimethoprim-sulfamethoxazole (TMP-SMX).   Methods . Case report of a patient with microbiologically proven scleritis due to  Nocardia asteroides .  Results . The patient presented with pain, redness, and nodules on the sclera three months following pterygium excision with mitomycin C and amniotic membrane placement. As no response was noted with empiric treatment for bacterial scleritis, debridement was performed. The cytopathology report showed gram positive filamentous bacteria. A presumptive diagnosis of Nocardia scleritis was made and therapy was initiated based on a literature review on treatments for  Nocardia  infections. Cultures returned growing  Nocardia asteroides . Antibiotic sensitivity testing revealed resistance to linezolid and TMP-SMX which are the traditional drugs of choice for  Nocardia . The patient was treated with amikacin and imipenem as well as extensive debridement with pedicle grafts. The patient's scleritis resolved with a good visual outcome.  Conclusions . Cultures should be obtained in all cases of necrotizing scleritis in patients with a recent history of conjunctival surgery to rule out unusual organisms such as  Nocardia . Although literature states that resistance to linezolid and TMP-SMX is rare in  Nocardia , sensitivity testing can be useful in unresponsive cases.

Scleritis Caused byIn VitroLinezolid-ResistantNocardia asteroides