Chang Eileen L, Chu Rachel L, Wittpenn John R, Perry Henry D
Department of Ophthalmology, Nassau University Medical Center, East Meadow, NY, 11554, USA.
Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11794, USA.
Am J Ophthalmol Case Rep. 2021 Feb 13;22:101030. doi: 10.1016/j.ajoc.2021.101030. eCollection 2021 Jun.
keratitis is a rare type of infectious keratitis and may mimic other corneal diseases and lead to delay in diagnosis. This case illustrates how often escapes accurate diagnosis due to its insidious onset, variable clinical manifestations, and unusual characteristics on cultures.
The patient presented with an epithelial defect and superior pannus and scarring, which was misdiagnosed as superior limbic keratoconjunctivitis (SLK) and herpes simplex virus (HSV) keratitis. Repeat corneal scraping cultures, smears, and conjunctival biopsy were necessary to elucidate the diagnosis. It can be effectively treated with the intravenous preparation of trimethoprim-sulfamethoxazole 80 mg/mL (brand name SEPTRA) used topically as eye drops.
The diagnosis of keratitis relies on a high clinical suspicion and a prompt corneal scraping with culture. Due to its potential for rapid resolution with early therapy, it is important to isolate early in its disease course.
Topical amikacin had been the standard of care for keratitis for many years. However, recently there is increasing resistance of Nocardia to amikacin. SEPTRA offers an alternative therapy. keratitis mimics other infectious and inflammatory etiologies so rapid diagnosis and treatment is critical in the prevention of long-term complications.
奴卡菌性角膜炎是一种罕见的感染性角膜炎，可能会与其他角膜疾病相似，导致诊断延误。本病例说明了由于其隐匿性发作、临床表现多样以及培养结果具有不寻常特征，奴卡菌性角膜炎是多么常被漏诊。
该患者表现为上皮缺损、上方血管翳和瘢痕形成，最初被误诊为上方边缘性角膜结膜炎（SLK）和单纯疱疹病毒（HSV）角膜炎。需要多次进行角膜刮片培养、涂片和结膜活检才能明确诊断。用静脉制剂甲氧苄啶 - 磺胺甲恶唑80mg/mL（商品名SEPTRA）局部滴眼可有效治疗。
奴卡菌性角膜炎的诊断依赖于高度的临床怀疑和及时进行角膜刮片培养。由于早期治疗有迅速缓解的可能，因此在疾病早期进行隔离很重要。
多年来，局部使用阿米卡星一直是奴卡菌性角膜炎的标准治疗方法。然而，最近奴卡菌对阿米卡星的耐药性不断增加。SEPTRA提供了一种替代疗法。奴卡菌性角膜炎与其他感染性和炎症性病因相似，因此快速诊断和治疗对于预防长期并发症至关重要。
