Dr. Gaurav Agarwal, Dr. Mohit Gajbhiye, Dr. Lomesh Dnyaneshwar Patil, Dr. Sudhakar Potti
A 45 year old male presented with c/o of watering,photophobia, redness, DOV in L/E since 10 days with no H/O discharge,trauma,refractive surgery,steroid use .He consulted to local ophthalmologist diagnosed as a viral keratitis treated with antiviral topically.
R/E examination was WNL. On L/E examination swollen lids, circumcorneal congestion, with presence of multiple, subepithelial pinhead shaped infiltrate over cornea having clear cornea in between, corneal sensation was normal. Fluorescein stain test was negative.Rest of the left eye was WNL.
CBC & RBS-WNL
HIV & HBsAg-negative
Gram stain-gram postive slender branching filaments seen
KOH mount-no organism seen
On the basis of gram stain we diagnosed NOCARDIA KERATITIS.
Patient was treated by FF Amikacin(2%) hourly. After a week lesion subsided completely.
Discussion-A nonresolving multiple subepithelial corneal infiltrates arises suspicious of atypical lesion.We should investigate for nocardia & microsporidiasis keratitis