Abstract
Infective keratitis can on occasion end up in diagnostic difficulty. This is more so if the patient is on immunosuppressants as it can alter the clinical presentation. We report a case of a 39 year old patient who underwent a renal transplantation in 2007, and currently on immunosuppressants. She presented with a painful red eye and had features of marginal keratitis. There was a poor response to empirical antibiotic therapy. Due to the prolonged disease process and infiltration of the cornea, she had an imminent perforation. Following surgical intervention and appropriate antibiotic therapy following identification of the causative organism as Nocardia spp. she made a full recovery. Although there are a few case reports of Nocardia keratitis in immuno-compromised patients in the international literature, this appears to be the first documented case reported in Sri Lanka. DOI: http://dx.doi.org/10.4038/sljid.v3i2.5727 Sri Lankan Journal of Infectious Diseases 2013; Vol.3(2):43-45
Highlights
The management of infective keratitis is challenging
As therapy, fortified amikacin and ciprofloxacin eye drops with co-trimoxazole tablets were commenced
Over the last few decades there have been a number of sporadic cases reported with Nocardia keratitis, but there is no previously published evidence of a similar case in Sri Lanka
Summary
The management of infective keratitis is challenging. Difficulties may be encountered if the infective agent shows poor response to the anti-microbial agent or if the diagnosis is delayed. Examination confirmed blepharitis and an infiltration in the inferior cornea and moxifloxacin eye drops were started empirically. With the presence of blepharitis, a diagnosis of marginal keratitis was made and topical dexamethazone commenced. Culture samples from the abscess did not yield a causative organism.
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