Nocardia keratitis presenting as an anterior chamber ball of exudates and its management

Abstract

A man in late 40s presented with corneal ulcer of the right eye of 1 month duration. He had a central corneal epithelial defect measuring 4.6×4.2 mm with an underlying 3.6×3.5 mm anterior to mid stromal patchy infiltrate and 1.4 mm hypopyon. Gram stain of the colonies on chocolate agar showed presence of confluent thin branching, gram-positive beaded filaments, which were positive after 1% acid fast stain. This confirmed our organism to be Nocardia sp. Topical amikacin was started but continued worsening of the infiltrate and presence of a ball of exudates in the anterior chamber, prompted the use of systemic trimethoprim-sulfamethoxazole. There was a dramatic improvement in the signs and symptoms, with complete resolution of infection over a period of 1 month.

A Rare Case Report of Disseminated Nocardia Farcinica Granulomatous Hepatitis and Clinical Management Experience

“…20,21 Additionally, literature reports indicate that Nocardia may also cause conditions such as exudative choroiditis, retinal abscess, iridocyclitis, keratitis, peritonitis, arthritis, and infective endocarditis. [22][23][24] Clinical reports on Nocardia-induced liver infections are relatively scarce, with manifestations typically involving the formation of hepatic granulomas and liver abscesses. 25,26 In most cases, Nocardia infections are extremely rare, but should be considered when results for more common causes are negative.…”