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Nocardia keratitis mimicking superior limbic keratoconjunctivitis and herpes simplex virus

Authors
  • Chang, Eileen L.1
  • Chu, Rachel L.2
  • Wittpenn, John R.3
  • Perry, Henry D.1, 3
  • 1 Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY, 11554, USA
  • 2 Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA
  • 3 Division of Cornea and Refractive Surgery, Ophthalmic Consultants of Long Island, Rockville Centre, NY, 11570, USA
Type
Published Article
Journal
American Journal of Ophthalmology Case Reports
Publisher
Elsevier
Publication Date
Feb 13, 2021
Volume
22
Identifiers
DOI: 10.1016/j.ajoc.2021.101030
PMID: 33665477
PMCID: PMC7900621
Source
PubMed Central
Keywords
Disciplines
  • Case Report
License
Unknown

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.

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