Ocular Nocardiosis Mistaken For Fungal Corneal Ulcer
Published 2026 - 44th Congress of the ESCRS
Reference: PPE1.08 | Type: ESONT Abstract | DOI: 10.82333/2d0m-z644
Authors: Dr Sharah Rahman Rahman*, Dr Jalal Ahmed 1 , Dr Ishtiaque Anwar 1 , Dr Arif Hayat Khan Pathan 2 , Dr Tarzia Asma Zafrullah 3
1Cataract and Cornea,Bangladesh Eye Hospital and Institute,Dhaka,Bangladesh, 2Retina,Retina Glaucoma Center,Dhaka,Bangladesh, 3Paediatric Ophthalmology,Lions Eye Institute and Hospital,Dhaka,Bangladesh
Purpose
To report a case of Nocardia keratitis mimicking fungal infection following agricultural trauma. The report emphasises the importance of microbiological diagnosis in preventing delayed management and irreversible vision loss when empirical antifungal therapy fails.
Setting
Tertiary care ophthalmic center involving a 47-year-old female patient from a rural farming community.
Methods
A 47-year-old woman presented with a painful red eye and vision limited to hand movements after one month of failed empirical antifungal treatment (topical natamycin, clotrimazole, and oral ketoconazole). Slit-lamp examination showed a dry, feathery stromal ulcer and a 2mm hypopyon. Corneal scrapings were performed for potassium hydroxide (KOH) wet mount and Gram staining to differentiate between fungal and bacterial etiologies.
Results
KOH mount was negative for fungal filaments. Gram stain revealed thin, beaded, branching, Gram-positive filaments suggestive of Nocardia species. Antifungals were replaced with topical amikacin 2%, tobramycin ointment, and oral moxifloxacin. Rapid improvement occurred within one week. After one month, the ulcer healed with a faint scar. Best-corrected visual acuity improved to 6/18; residual blurring was attributed to corneal astigmatism.
Conclusions
Nocardia keratitis is a potent mimic of fungal keratitis. Early laboratory confirmation via Gram stain is essential to initiate targeted antibiotic therapy. This approach prevents prolonged, ineffective treatment and ensures favourable visual outcomes.