The Various Presentations Of Ocular Nocardiosis : A Case Series

To report a case series depicting the varying presentations of Ocular Nocardial infections.

L V Prasad Eye Institute, Hyderabad (India)

We report a case series of 3 patients with varying presentations of Ocular Nocardiosis. The 1st patient, 34-year-old female,presented with a corneal infiltrate after trauma with vegetative matter,being treated with antifungals elsewhere. The infiltrate measuring 6x5mm, was arranged in a wreath like pattern with pinhead lesions,along with a hypopyon. Scraping & culture revealed Nocardia species. She was treated with hourly topical amikacin 2.5% and thrice daily atropine 1%, responded well with total resolution in 2 months with a VA of 20/25. The 2nd patient, a 43-year-old female presented with a 2.6x2.5mm infiltrate abutting the limbus, following foreign body exposure. Scraping & culture revealed Nocardia species & she was treated with hourly topical Amikacin 2.5% & thrice daily atropine & responded well initially but presented 1 month later with worsening symptoms & development of a large scleral abscess, next to the infiltrate. She was treated with systemic antibiots & responded slowly with complete resolution in 2 months. The 3rd patient,49-year-old male,presented with a scleral nodule following a fingernail injury, treated as episcleritis elsewhere. Inflammatory causes were ruled out & debridement was done & micro and HE analysis of samples revealed Nocardia species. He was treated with hourly topical amikacin 2.5% but due to a very slow response,he was to switched to IV Amikacin 500mg BD which hastened recovery with complete resolution in 2 months with a final VA of 20/60

Ocular nocardiosis is a relatively uncommon presentation in clinical practice and unfamiliarity with the pathogen, presentation and difficulty in differentiating these infections from fungal keratitis can lead to a delay or administration of inappropriate treatment which can prolong the infection and cause significant ocular morbidity. A high degree of clinical suspicion, with appropriate diagnostic tests will help early diagnosis and prompt initiation of treatment usually leads to a favourable outcome. With this case series we aim to demonstrate the various presentations of ocular nocardiosis and to document favourable outcomes due to prompt diagnosis and treatment.