Diagnostic Challenges in Nocardia Keratitis

Joséphine Behaegel, Sorcha Ní Dhubhghaill, Carina Koppen

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


OBJECTIVE: To present a case of diagnostic confusion in Nocardia keratitis in a contact lens wearer and to illustrate the characteristic clinical findings of this rare entity.

METHODS: Case report of Nocardia keratitis that was mistaken for acanthamoeba, herpetic, and fungal keratitis in three tertiary corneal referral centers before the correct diagnosis of Nocardia infection was made.

RESULTS: A 29-year-old contact lens wearer was referred to our hospital for a contact lens-associated bacterial keratitis, not improving under standard bacterial treatment. Biomicroscopy revealed a circular corneal ulcer and pinhead lesions arranged in a wreath pattern. Initial scraping revealed no positive cultures and confocal microscopy findings were suspicious for fungal keratitis. Only after a poor response to protozoal and fungal treatment, and a negative herpes serology, Nocardia was suspected. This suspicion was confirmed with a positive culture and the topical amikacin and ciprofloxacin were started. The infiltrate responded promptly and resolved, leaving a small corneal scar and a good visual recovery.

CONCLUSION: Because of its infrequent occurrence and its variable clinical picture, Nocardia keratitis is easily misdiagnosed. Although a rare entity, this infection should be added to the differential diagnosis in contact lens-related keratitis not responding to first-line antibiotics and presenting with patchy anterior stromal infiltrates.

Original languageEnglish
Pages (from-to)S370-S372
Number of pages3
JournalEye & Contact Lens
Issue numbers1
Early online date5 Dec 2017
Publication statusPublished - Sep 2018


  • Adult
  • Cornea/microbiology
  • Diagnosis, Differential
  • Eye Infections, Bacterial/diagnosis
  • Female
  • Humans
  • Keratitis/diagnosis
  • Nocardia Infections/diagnosis
  • Nocardia/isolation & purification


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