J Korean Ophthalmol Soc.  2025 Jan;66(1):70-74. 10.3341/jkos.2025.66.1.70.

A Recurrent Nocardial Corneal Ulcer

• Chung HY
• Lee TE
• You IC

• KMID: 2563923
• DOI: http://doi.org/10.3341/jkos.2025.66.1.70

Abstract

Purpose
To present a case of recurrent Nocardia keratitis following the use of topical steroids.
Case summary
A 57-year-old man presented with decreased visual acuity and conjunctival injection in the right eye which began 15 days prior. Slit-lamp examination revealed epithelial defects smaller than the circular infiltrate and empirical topical treatment was initiated. Since the corneal lesion improved with a therapeutic contact lens and topical antibiotics, a steroid eye drop was added. After 7 days, the corneal infiltrate worsened in a wreath-like pattern with a positive result on a KOH (potassium hydroxide) smear, and antifungal eye drops were started. However, Nocardia species was confirmed on the 9th day of culture. While complete epithelial regeneration was achieved after 10 days using amikacin eye drops, steroid eye drops were reused to reduce the corneal haze. Twenty days later, the corneal infiltrate and epithelial defects reappeared adjacent to the initial opacity, and a culture confirmed Nocardia. Gradual improvement was achieved with amikacin eye drops and oral Septrin. Ultimately, a combination of moxifloxacin, tobramycin, and bromfenac eye drops was tapered over several months, resulting in healing with mild opacity.
Conclusions
Nocardia keratitis commonly arises from trauma involving soil, progresses slowly, and is often misdiagnosed as a fungal infection. While amikacin eye drops proved effective, prolonged topical treatment is essential. Early steroid use should be considered cautiously, as it may lead to recurrence and worsening of the corneal lesion.

Keyword

Corneal ulcer, Nocardia, Steroid, Topical amikacin