Nocardia transvalensis keratitis: an emerging pathology among travelers returning from Asia

A 23-year-old man presented with a 10-week history of ocular pain, redness, and blurred vision in his right eye following a projectile foreign body impacting the cornea while motor biking in Tha？land. At presentation, a central epithelial defect with a central whitish stromal infiltrate associated with pinhead satellite infiltrates was observed. Identification with 16S rRNA PCR sequencing and microbiological culture of corneal scraping and revealed N. transvalensis as the causative organism. Treatment was initiated with intensive topical amikacin, oral ketoconazole and oral doxycycline. After a four-week treatment period, the corneal infiltrate decreased so that only a faint subepithelial opacity remained.Nocardia organisms should be suspected as the causative agent of any case of keratitis in travelers returning from Asia. With appropriate therapy, Nocardia keratitis resolves, resulting in good visual outcome.Nocardia spp. keratitis is an aggressive ocular infection, typically following a corneal trauma. The diagnosis is often delayed, which can lead to a corneal scar [1]. While the most commonly identified agents have been Nocardia asteroides and Nocardia brasiliensis in the pre-molecular area [2], new species are now identified thanks to molecular methods and later two species are now rarely identified as clinical isolation. Herein, we report one case of Nocardia transvalensis keratitis, illustrating this emerging pathology among travelers returning from Asia.A 23-year-old man presented with redness, pain and decreased visual acuity in his right eye following an injury caused by dust while driving a motorcycle in Thailand. Despite topical treatment with prednisolone and neomycin prescribed by a local ophthalmologist, the ocular condition did not improve after four weeks. Ten weeks later, the patient was referred to our ophthalmology department for further management of a persistent corneal ulcer. Upon initial examination, visual acuity was limited to "counting fi