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Title
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Diagnostic challenges in Nocardia Keratitis
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Author
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Abstract
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| Objective: To present a case of diagnostic confusion in Nocardia keratitis in a contact lens wearer and to illustrate the characteristic clinical findings of this rare entity. Methods: Case report of Nocardia keratitis that was mistaken for acanthamoeba, herpetic, and fungal keratitis in three tertiary corneal referral centers before the correct diagnosis of Nocardia infection was made. Results: A 29-year-old contact lens wearer was referred to our hospital for a contact lens-associated bacterial keratitis, not improving under standard bacterial treatment. Biomicroscopy revealed a circular corneal ulcer and pinhead lesions arranged in a wreath pattern. Initial scraping revealed no positive cultures and confocal microscopy findings were suspicious for fungal keratitis. Only after a poor response to protozoal and fungal treatment, and a negative herpes serology, Nocardia was suspected. This suspicion was confirmed with a positive culture and the topical amikacin and ciprofloxacin were started. The infiltrate responded promptly and resolved, leaving a small corneal scar and a good visual recovery. Conclusion: Because of its infrequent occurrence and its variable clinical picture, Nocardia keratitis is easily misdiagnosed. Although a rare entity, this infection should be added to the differential diagnosis in contact lens-related keratitis not responding to first-line antibiotics and presenting with patchy anterior stromal infiltrates. |
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Language
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English
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Source (journal)
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Eye & contact lens: science and clinical practice
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Publication
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2018
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ISSN
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1542-2321
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DOI
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10.1097/ICL.0000000000000462
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Volume/pages
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44
:s:[1]
(2018)
, p. S370-S372
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ISI
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000457837000072
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Pubmed ID
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29219900
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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