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Case Reports
. 2021 Feb 13:22:101030.
doi: 10.1016/j.ajoc.2021.101030. eCollection 2021 Jun.

Nocardia keratitis mimicking superior limbic keratoconjunctivitis and herpes simplex virus

Eileen L Chang  1 , Rachel L Chu  2 , John R Wittpenn  3 , Henry D Perry  1   3
Affiliations
Case Reports

Nocardia keratitis mimicking superior limbic keratoconjunctivitis and herpes simplex virus

Eileen L Chang et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: Nocardia keratitis is a rare type of infectious keratitis and may mimic other corneal diseases and lead to delay in diagnosis. This case illustrates how Nocardia often escapes accurate diagnosis due to its insidious onset, variable clinical manifestations, and unusual characteristics on cultures.

Observation: The patient presented with an epithelial defect and superior pannus and scarring, which was misdiagnosed as superior limbic keratoconjunctivitis (SLK) and herpes simplex virus (HSV) keratitis. Repeat corneal scraping cultures, smears, and conjunctival biopsy were necessary to elucidate the diagnosis. It can be effectively treated with the intravenous preparation of trimethoprim-sulfamethoxazole 80 mg/mL (brand name SEPTRA) used topically as eye drops.

Conclusion: The diagnosis of Nocardia keratitis relies on a high clinical suspicion and a prompt corneal scraping with culture. Due to its potential for rapid resolution with early therapy, it is important to isolate Nocardia early in its disease course.

Importance: Topical amikacin had been the standard of care for Nocardia keratitis for many years. However, recently there is increasing resistance of Nocardia to amikacin. SEPTRA offers an alternative therapy. Nocardia keratitis mimics other infectious and inflammatory etiologies so rapid diagnosis and treatment is critical in the prevention of long-term complications.

Keywords: Cornea; HSV; Infection; Keratitis; Nocardia; SLK.

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Figures

Fig. 1
Fig. 1
Clinical photograph of the patient's right eye on initial presentation to second corneal specialist (3 months from first symptoms) demonstrating superior pannus, anterior stromal scarring, conjunctival injection, and floppy eyelids.
Fig. 2
Fig. 2
Papinicolau stain magnified 400X of corneal scraping demonstrating branching filaments characteristic of Nocardia asteroides.
See this image and copyright information in PMC

References

    1. Sridhar M.S., Gopinathan U., Garg P., Sharma S., Rao G.N. Ocular Nocardia infections with special emphasis on the cornea. Surv Ophthalmol. 2001;45(5):361–378. doi: 10.1016/s0039-6257(00)00207-1. - DOI - PubMed
    1. Perry H.D., Nauheim J.S., Donnenfeld E.D. Nocardia asteroides keratitis presenting as a persistent epithelial defect. Cornea. 1989;8(1):41–44. - PubMed
    1. Sridhar M.S., Sharma S., Reddy M.K., Mruthyunjay P., Rao G.N. Clinicomicrobiological review of Nocardia keratitis. Cornea. 1998;17(1):17–22. doi: 10.1097/00003226-199801000-00003. - DOI - PubMed
    1. Lalitha P. Nocardia keratitis. Curr Opin Ophthalmol. 2009;20(4):318–323. doi: 10.1097/ICU.0b013e32832c3bcc. - DOI - PubMed
    1. Parsons M.R., Holland E.J., Agapitos P.J. Nocardia asteroides keratitis associated with extended-wear soft contact lenses. Can J Ophthalmol. 1989;24(3):120–122. - PubMed

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