A complex case of Nocardia keratitis: challenges in diagnosis and therapy

Nocardia keratitis is a rare cause of microbial keratitis, primarily affecting patients in tropical and subtropical regions. Its diagnostic challenge arises from this keratitis uncommon presentation, which often mimics other infectious keratitis types, leading to delays in appropriate treatment. This case report aims to elucidate the complexities of diagnosing and managing Nocardia keratitis of a 41-year-old male who had a chronic, progressively worsening wreath-pattern corneal infiltrate and hypopyon following ocular trauma. Initial empirical treatments were ineffective. Diagnostic confirmation via corneal scraping culture enabled targeted antimicrobial therapy. Subconjunctival amikacin and topical tobramycin led to gradual improvement, though complications such as corneal scarring and neovascularization remained, indicating potential need for surgical intervention. This case emphasizes the importance of high clinical suspicion and precise laboratory diagnostics in managing rare cases of Nocardia keratitis. Establishing standardized treatment guidelines for rare ocular infections could improve clinical outcomes.