目的:报告诺卡式菌属感染引起的盘状角膜炎病例1例。方法:病例报告。结果:患者,男,13岁,无角膜接触镜使用史,在小溪里游泳后,右眼疼痛伴视力下降2wk。最佳矫正视力:右眼6/30(0.2)。检查发现角膜基质存在形态规则的旁中心盘状浸润伴炎症反应。角膜敏感度下降。最初角膜刮片镜检行革兰氏染色阴性,棘阿米巴角膜刮片和培养阴性。诊断为病毒性盘状角膜炎,给予口服阿昔洛韦和局部使用激素眼药水。2wk后患者视力恶化伴角膜损伤加重,再次角膜取材刮片行革兰氏染色提示诺卡式菌属感染,按经验局部给予3g/L加替沙星眼药水后,临床效果明显。治疗6mo后,视力达到6/6仅在角膜中心留有少量角膜混浊。结论:诺卡式菌属感染延误诊断可以导致病情恶化。如果采用正确的治疗,诺卡式菌属感染引起的角膜炎可以恢复良好,仅留少量瘢痕,获得较好的视力。

AIM:To report a case of Nocardia keratitis presenting as viral disciform keratitisMETHODS:A case report.RESULTS:A 13-year-old boy,a non-contact lens user,presented with painful reduced vision of the right eye after following history of swimming in the stream for two weeks duration.Best-corrected visual acuity of the right eye was 6/30.There was a well-defined para-central disciform stromal infiltration with inflammatory reactions.A corneal sensation was diminished.Initial corneal scrapping for gram stain,Acanthamoeba smear and culture and sensitivity was found to be negative.He was diagnosed as presumed viral disciform keratitis and treated with oral acyclovir and topical steroid.Two weeks later,his vision became deteriorated associated with worsening of the corneal lesion.Re-scrapping corneal specimen for gram stain showed features of Nocardia sp.Topical Gatifloxacin 3g/L was commenced empirically and it showed rapid clinical response.His visual acuity was improved to 6/6 six months after treatment with minimal corneal opacity sparing the visual axis.CONCLUSION:Delay in diagnosis of Nocardia keratitis may lead to worsening of the condition.If proper treatment is initiated,Nocardia keratitis resolves with minimal scarring and good visual recovery.

R772.21