Nocardia Amikacinitolerans Corneal Ulcer

A 31-year-old male presented to the Bascom Palmer Eye Institute ER with six weeks of decreased vision in the right eye. Examination revealed 20/70 vision, a white and quiet eye, with a stromal corneal infiltrate and elevated IOP. The patient was treated with antibacterial and steroid drops, and oral antivirals, for several weeks with worsening of vision, redness, and pain in the eye. The vision worsened to CF. Cultures from corneal scraping became positive for Nocardia spp nine days after culture. The patient discontinued steroid drops and started empiric treatment for nocardia (amikacin and moxifloxacin), with mild improvement in symptoms and exam. The final culture results showed multi-drug resistant Nocardia amikacinitolerans that was resistant to amikacin and moxifloxcin, but sensitive to tobramycin. The patient was switched to tobramycin eye drops, with improvement in vision and symptoms. 

Presentation Date: 09/19/2019

Issue Date: 08/01/2020