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Nocardia keratitis presenting as an anterior chamber ball of exudates and its management
  1. Maneesha Mohan Bellala1,
  2. Poornima Sharma Tandra1,
  3. Bhupesh Bagga2 and
  4. Bhagyashree Madduri3
  1. 1Cornea and Anterior Segment, LV Prasad Eye Institute GMR Varalakshmi Campus, Visakhapatnam, India
  2. 2Cornea, LV Prasad Eye Institute, Hyderabad, India
  3. 3Ocular Microbiology Service, LV Prasad Eye Institute GMR Varalakshmi Campus, Visakhapatnam, India
  1. Correspondence to Dr Maneesha Mohan Bellala; maneeshabellala{at}


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.

  • Anterior chamber
  • Drugs: infectious diseases

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  • Contributors MMB was involved in pt care from intial presentation to last follow-up. BB for providing valuable inputs during the treatment. PST was involved in drafting of the manuscript. BB and BM were involved in critical revision of the manuscript for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.