Nocardia keratitis presenting as viral disciform keratitis,a case report

Abstract:

AIM:To report a case of Nocardia keratitis presenting as viral disciform keratitisMETHODS:A case report.RESULTS:A 13-year-old boy,a non-contact lens user,presented with painful reduced vision of the right eye after following history of swimming in the stream for two weeks duration.Best-corrected visual acuity of the right eye was 6/30.There was a well-defined para-central disciform stromal infiltration with inflammatory reactions.A corneal sensation was diminished.Initial corneal scrapping for gram stain,Acanthamoeba smear and culture and sensitivity was found to be negative.He was diagnosed as presumed viral disciform keratitis and treated with oral acyclovir and topical steroid.Two weeks later,his vision became deteriorated associated with worsening of the corneal lesion.Re-scrapping corneal specimen for gram stain showed features of Nocardia sp.Topical Gatifloxacin 3g/L was commenced empirically and it showed rapid clinical response.His visual acuity was improved to 6/6 six months after treatment with minimal corneal opacity sparing the visual axis.CONCLUSION:Delay in diagnosis of Nocardia keratitis may lead to worsening of the condition.If proper treatment is initiated,Nocardia keratitis resolves with minimal scarring and good visual recovery.

Key words:Nocardia keratitis;disciform keratitis;keratitis