Posters

Nocardia abscessus keratitis after exposure to contaminated waters

Poster Details

First Author: A.Latorre Garicano SPAIN

Co Author(s):    B. Salvador-Cullá   E. Roquet-Puigneró   V. Lázaro-Rodríguez              

Abstract Details

Purpose:

The purpose of this case is to describe the clinical signs of Nocardia Abscessus keratitis and to emphasize the importance of considering it in a diferencial diagnosis faced with an antiamoebic treatment reffractary keratitits. The case also remarks the importance of incorporating in vivo microscopic examinations as microbiological exams when encountering diagnostic and therapeutical challenges with uncommon corneal infections.

Setting:

Centro de Oftalmología Barraquer, Barcelona (Spain)

Methods:

Retrospective case report. Our report describes a 16 year-old man with less than a month history of a left ocular pain and discomfort  after the exposure to contaminated waters. Contact lenses wearer during 4 years.  Ophtalmological examination revealed a 4mm diameter beading, circular lesion with some lines which remembers the herpetic dendrite, and a discreet estromal infiltration. Confocal microscopy and epithelial scraping for PCR were performed. Furthermore samples for Giemsa staining and cultures were taken.

Results:

Best subjective corrected visual acuity (BSCVA) was 0,85 (left eye). A 4mm-diameter beading, circular lesion in the inferior-nasal quadrant was found. The epithelium was entire and irregular. Little and slim branched, highly reflective filaments were distinguished in the confocal microscopy. The PCR result for Acanthamoeba was negative. Therefore, PCR for fungi and universal bacterias was performed, being positive for Nocardia Abscessus. The cultures showed aerobic actynomicetes. After failing other therapies and according to the results, it was treated with Trimethoprim-sulfamethxazole, Trimethoprim, Tobramycin and Tobramycin and dexamethasone.  4 weeks later 100% epithelization, absence of abscess and  1,2 BSCVA was obtained.

Conclusions:

The corneal infection caused by Nocardia spp. is a rare condition being the traumatism the most common predisposing factor. Clinicaly, it could be misdiagnosed because of its lack of familiarity or its clinical similarity with the fungal or micobacterial  keratitis. Therefore, it is important to consider infrecuent etiologies more specially if the patient refers history of traumatism.

Financial Disclosure:

None