Nocardia keratitis mimicking superior limbic keratoconjunctivitis and herpes simplex virus
Nocardia keratitis is a rare type of infectious keratitis and may mimic other corneal diseases and lead to delay in diagnosis. This case illustrates how Nocardia often escapes accurate diagnosis due to its insidious onset, variable clinical manifestations, and unusual characteristics on cultures. Th...
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| Published in: | American journal of ophthalmology case reports Vol. 22; p. 101030 |
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| Main Authors: | , , , |
| Format: | Journal Article |
| Language: | English |
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| Abstract | Nocardia keratitis is a rare type of infectious keratitis and may mimic other corneal diseases and lead to delay in diagnosis. This case illustrates how Nocardia often escapes accurate diagnosis due to its insidious onset, variable clinical manifestations, and unusual characteristics on cultures.
The patient presented with an epithelial defect and superior pannus and scarring, which was misdiagnosed as superior limbic keratoconjunctivitis (SLK) and herpes simplex virus (HSV) keratitis. Repeat corneal scraping cultures, smears, and conjunctival biopsy were necessary to elucidate the diagnosis. It can be effectively treated with the intravenous preparation of trimethoprim-sulfamethoxazole 80 mg/mL (brand name SEPTRA) used topically as eye drops.
The diagnosis of Nocardia keratitis relies on a high clinical suspicion and a prompt corneal scraping with culture. Due to its potential for rapid resolution with early therapy, it is important to isolate Nocardia early in its disease course.
Topical amikacin had been the standard of care for Nocardia keratitis for many years. However, recently there is increasing resistance of Nocardia to amikacin. SEPTRA offers an alternative therapy. Nocardia keratitis mimics other infectious and inflammatory etiologies so rapid diagnosis and treatment is critical in the prevention of long-term complications. |
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| AbstractList | Nocardia keratitis is a rare type of infectious keratitis and may mimic other corneal diseases and lead to delay in diagnosis. This case illustrates how Nocardia often escapes accurate diagnosis due to its insidious onset, variable clinical manifestations, and unusual characteristics on cultures.
The patient presented with an epithelial defect and superior pannus and scarring, which was misdiagnosed as superior limbic keratoconjunctivitis (SLK) and herpes simplex virus (HSV) keratitis. Repeat corneal scraping cultures, smears, and conjunctival biopsy were necessary to elucidate the diagnosis. It can be effectively treated with the intravenous preparation of trimethoprim-sulfamethoxazole 80 mg/mL (brand name SEPTRA) used topically as eye drops.
The diagnosis of Nocardia keratitis relies on a high clinical suspicion and a prompt corneal scraping with culture. Due to its potential for rapid resolution with early therapy, it is important to isolate Nocardia early in its disease course.
Topical amikacin had been the standard of care for Nocardia keratitis for many years. However, recently there is increasing resistance of Nocardia to amikacin. SEPTRA offers an alternative therapy. Nocardia keratitis mimics other infectious and inflammatory etiologies so rapid diagnosis and treatment is critical in the prevention of long-term complications. Purpose: Nocardia keratitis is a rare type of infectious keratitis and may mimic other corneal diseases and lead to delay in diagnosis. This case illustrates how Nocardia often escapes accurate diagnosis due to its insidious onset, variable clinical manifestations, and unusual characteristics on cultures. Observation: The patient presented with an epithelial defect and superior pannus and scarring, which was misdiagnosed as superior limbic keratoconjunctivitis (SLK) and herpes simplex virus (HSV) keratitis. Repeat corneal scraping cultures, smears, and conjunctival biopsy were necessary to elucidate the diagnosis. It can be effectively treated with the intravenous preparation of trimethoprim-sulfamethoxazole 80 mg/mL (brand name SEPTRA) used topically as eye drops. Conclusion: The diagnosis of Nocardia keratitis relies on a high clinical suspicion and a prompt corneal scraping with culture. Due to its potential for rapid resolution with early therapy, it is important to isolate Nocardia early in its disease course. Importance: Topical amikacin had been the standard of care for Nocardia keratitis for many years. However, recently there is increasing resistance of Nocardia to amikacin. SEPTRA offers an alternative therapy. Nocardia keratitis mimics other infectious and inflammatory etiologies so rapid diagnosis and treatment is critical in the prevention of long-term complications. keratitis is a rare type of infectious keratitis and may mimic other corneal diseases and lead to delay in diagnosis. This case illustrates how often escapes accurate diagnosis due to its insidious onset, variable clinical manifestations, and unusual characteristics on cultures. The patient presented with an epithelial defect and superior pannus and scarring, which was misdiagnosed as superior limbic keratoconjunctivitis (SLK) and herpes simplex virus (HSV) keratitis. Repeat corneal scraping cultures, smears, and conjunctival biopsy were necessary to elucidate the diagnosis. It can be effectively treated with the intravenous preparation of trimethoprim-sulfamethoxazole 80 mg/mL (brand name SEPTRA) used topically as eye drops. The diagnosis of keratitis relies on a high clinical suspicion and a prompt corneal scraping with culture. Due to its potential for rapid resolution with early therapy, it is important to isolate early in its disease course. Topical amikacin had been the standard of care for keratitis for many years. However, recently there is increasing resistance of Nocardia to amikacin. SEPTRA offers an alternative therapy. keratitis mimics other infectious and inflammatory etiologies so rapid diagnosis and treatment is critical in the prevention of long-term complications. |
| ArticleNumber | 101030 |
| Author | Chu, Rachel L. Perry, Henry D. Wittpenn, John R. Chang, Eileen L. |
| Author_xml | – sequence: 1 givenname: Eileen L. orcidid: 0000-0003-2223-9736 surname: Chang fullname: Chang, Eileen L. email: echang324@gmail.com, eileen.chang@yale.edu organization: Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY, 11554, USA – sequence: 2 givenname: Rachel L. orcidid: 0000-0003-0158-4768 surname: Chu fullname: Chu, Rachel L. organization: Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA – sequence: 3 givenname: John R. surname: Wittpenn fullname: Wittpenn, John R. organization: Division of Cornea and Refractive Surgery, Ophthalmic Consultants of Long Island, Rockville Centre, NY, 11570, USA – sequence: 4 givenname: Henry D. orcidid: 0000-0002-3088-0040 surname: Perry fullname: Perry, Henry D. organization: Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY, 11554, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33665477$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.3928/1081-597X-20070301-17 10.1136/bjo.63.6.449 10.1097/00003226-199801000-00003 10.1016/j.jcrs.2005.02.049 10.1016/S0161-6420(84)34207-5 10.1016/S0039-6257(00)00207-1 10.1016/0002-9394(82)90208-2 10.1097/ICL.0000000000000462 10.1097/ICO.0b013e318295e6b9 10.1097/00003226-198903000-00007 10.1097/ICO.0b013e318033d853 10.1097/ICO.0000000000000634 10.1097/ICU.0b013e32832c3bcc 10.1001/archopht.1987.01060040034016 10.1001/archopht.1970.00990040483016 |
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| Keywords | Infection Nocardia Cornea HSV Keratitis SLK |
| Language | English |
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| References_xml | – volume: 31 start-page: 2012 year: 2005 end-page: 2015 ident: bib8 article-title: Nocardia keratitis after laser in situ keratomileusis: clinicopathologic correlation publication-title: J Cataract Refract Surg contributor: fullname: Gonzalez-Fernandez – volume: 105 start-page: 464 year: 1987 ident: bib11 article-title: Nocardia asteroides as a cause of corneal ulcer publication-title: Arch Ophthalmol contributor: fullname: Sharma – volume: 20 start-page: 318 year: 2009 end-page: 323 ident: bib4 article-title: Nocardia keratitis publication-title: Curr Opin Ophthalmol contributor: fullname: Lalitha – volume: 23 start-page: 309 year: 2007 end-page: 312 ident: bib7 article-title: A cluster of Nocardia keratitis after LASIK publication-title: J Refract Surg contributor: fullname: Ramamurthy – volume: 94 start-page: 123 year: 1982 end-page: 124 ident: bib9 article-title: Nocardia asteroides corneal ulcer publication-title: Am J Ophthalmol contributor: fullname: Green – volume: 44 start-page: S370 year: 2018 end-page: S372 ident: bib12 article-title: Diagnostic challenges in Nocardia keratitis publication-title: Eye Contact Lens contributor: fullname: Koppen – volume: 15 start-page: 71 year: 1989 end-page: 73 ident: bib6 article-title: Nocardia asteroides keratitis: a case associated with soft contact lens wear publication-title: CLAO J contributor: fullname: Butler – volume: 26 start-page: 255 year: 2007 end-page: 259 ident: bib16 article-title: Nocardia keratitis: species, drug sensitivities, and clinical correlation publication-title: Cornea contributor: fullname: Srinivasan – volume: 32 start-page: 1499 year: 2013 end-page: 1501 ident: bib14 article-title: Treatment of superior limbic keratoconjunctivitis with topical tacrolimus 0.03% ointment publication-title: Cornea contributor: fullname: Mikropoulos – volume: 24 start-page: 120 year: 1989 end-page: 122 ident: bib5 article-title: Nocardia asteroides keratitis associated with extended-wear soft contact lenses publication-title: Can J Ophthalmol contributor: fullname: Agapitos – volume: 34 start-page: 1617 year: 2015 end-page: 1619 ident: bib17 article-title: Nocardia asteroides keratitis resistant to amikacin publication-title: Cornea contributor: fullname: Al-Mohtaseb – volume: 17 start-page: 17 year: 1998 end-page: 22 ident: bib3 article-title: Clinicomicrobiological review of Nocardia keratitis publication-title: Cornea contributor: fullname: Rao – volume: 91 start-page: 966 year: 1984 end-page: 968 ident: bib15 article-title: Conjunctival resection for superior limbic keratoconjunctivitis publication-title: Ophthalmology contributor: fullname: Wood – volume: 8 start-page: 41 year: 1989 end-page: 44 ident: bib2 article-title: Nocardia asteroides keratitis presenting as a persistent epithelial defect publication-title: Cornea contributor: fullname: Donnenfeld – volume: 45 start-page: 361 year: 2001 end-page: 378 ident: bib1 article-title: Ocular Nocardia infections with special emphasis on the cornea publication-title: Surv Ophthalmol contributor: fullname: Rao – volume: 63 start-page: 449 year: 1979 end-page: 454 ident: bib10 article-title: Nocardia asteroides keratitis publication-title: Br J Ophthalmol contributor: fullname: Stark – volume: 84 start-page: 481 year: 1970 end-page: 484 ident: bib13 article-title: Superior limbic keratoconjunctivitis. 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Clinical and pathological correlations publication-title: Arch Ophthalmol doi: 10.1001/archopht.1970.00990040483016 contributor: fullname: Theodore – volume: 24 start-page: 120 issue: 3 year: 1989 ident: 10.1016/j.ajoc.2021.101030_bib5 article-title: Nocardia asteroides keratitis associated with extended-wear soft contact lenses publication-title: Can J Ophthalmol contributor: fullname: Parsons |
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| Snippet | Nocardia keratitis is a rare type of infectious keratitis and may mimic other corneal diseases and lead to delay in diagnosis. This case illustrates how... keratitis is a rare type of infectious keratitis and may mimic other corneal diseases and lead to delay in diagnosis. This case illustrates how often escapes... Purpose: Nocardia keratitis is a rare type of infectious keratitis and may mimic other corneal diseases and lead to delay in diagnosis. This case illustrates... |
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| Title | Nocardia keratitis mimicking superior limbic keratoconjunctivitis and herpes simplex virus |
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