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

BMJ Case Rep. 2023 Feb 21;16(2):e251647. doi: 10.1136/bcr-2022-251647.

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.

Keywords: Anterior chamber; Drugs: infectious diseases.

Publication types

  • Case Reports

MeSH terms

  • Anterior Chamber
  • Anti-Bacterial Agents / therapeutic use
  • Exudates and Transudates
  • Humans
  • Keratitis* / diagnosis
  • Male
  • Nocardia Infections* / diagnosis
  • Nocardia*

Substances

  • Anti-Bacterial Agents