Nocardia Bacterial Keratitis

A patient presented to the Bascom Palmer Emergency Room with 2 weeks of red painful eye. On exam, he was found to have a patchy white stromal infiltrate suspicious for bacterial or fungal keratitis. Fortified antibiotics were started, and a culture was drawn. Ultimately it was found to be a rare form of nocardia keratitis caused by nocardia amikacinitolerans. The final treatment regimen consisted of fortified tobramycin and polytrim. Nocardia keratitis may present in an atypical fashion with risk factors and exam findings that appear consistent with fungal keratitis. Almost all species of nocardia are sensitive to amikacin, so it makes an excellent first line therapy, though tobramycin may be used effectively as well. Importantly, topical antibiotics should not be used in nocardia keratitis. Patients typically heal well with minimal sequelae with prompt and adequate treatment, as was the case with this patient, who had a final visual acuity of 20/25 after cessation of antibiotics.

Presentation Date: 08/08/2024

Issue Date: 08/23/2024