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Case Reports
. 2024 Jun 27;17(2):261-263.
doi: 10.4103/ojo.ojo_175_23. eCollection 2024 May-Aug.

Nocardia keratitis: A clinical diagnosis with successful outcome

Dubbaka Srujana  1 , Sandeep Shankar  1 , Kavita Bala Anand  2 , Mohini Agrawal  3 , Aanchal Singhal  4 , Ashok Kumar  1 , Divya Kochhar  1
Affiliations
Case Reports

Nocardia keratitis: A clinical diagnosis with successful outcome

Dubbaka Srujana et al. Oman J Ophthalmol. .

Abstract

Nocardia keratitis is mostly seen in patients with alcoholism, malnutrition, or HIV. Its chronic waxing-and-waning course makes it difficult to diagnose. A 53-year-old male presented with pain and redness in his right eye for the past 3 weeks. The cornea had paracentral ulcer with stromal infiltrates and multiple satellite lesions giving wreath-like appearance suggestive of Nocardia. After corneal scraping, fortified amikacin, moxifloxacin, and cycloplegics were started. Gram stain revealed filamentous, branching Gram-positive bacteria and acid-fast on Ziehl-Neelsen stain confirming our clinical diagnosis. Ulcer completely resolved over 6 weeks. Thus, a high index of clinical suspicion which was further backed by microbiological confirmation aided in expedient management ensuring a successful outcome.

Keywords: Corneal ulcer; Nocardia; keratitis; microbiology.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Slit-lamp images of the right eye with Nocardia keratitis showing gradual and progressive improvement from (a) at day 1; (b) at day 4; (c) at day 7; (d and e) at day 10 and (f) at 6 weeks
Figure 2
Figure 2
The modified Ziehl–Neelsen stained smear under oil immersion lens showing thin entangled acid-fast branching filamentous bacteria confirming Nocardia
See this image and copyright information in PMC

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