Diagnosis and management of paediatric Nocardia keratitis: a case report

Nocardia species are Gram-positive, aerobic actinomycetes. Nocardia keratitis is a rare ocular infection that is characterised by an atypical presentation and may be unresponsive to empirical antibiotic therapies. We report a case of Nocardia keratitis in a 10-year-old female patient caused by a corneal injury from a palm tree thorn marked by a delayed diagnosis and challenging management course. Initially, her visual acuity was counting fingers and treatment with moxifloxacin was ineffective. Multiple cultures returned negative for growth of pathogens, delaying the diagnosis of Nocardia species until day 32 from presentation. Once diagnosed, an aggressive antibiotic regimen was initiated. To address suboptimal control of infection and minimise the burden of frequent drops, an intrastromal ceftazidime injection was administered. Eventually, complete resolution and restoration of visual acuity were achieved. Nocardia keratitis is challenging to diagnose and requires prolonged treatment; however, early suspicion and appropriate management are associated with good prognosis and favourable outcomes.