Clinicopathological, Microbiological and Polymerase Chain Reaction Study in a Case of Nocardia Scleritis

Purpose: To describe the clinicopathological, microbiological and polymerase chain reaction (PCR) study in a case of Nocardia scleritis. Methods: A retrospective chart review. Results: A 32-year old male presented with pain, redness and nodular scleral swelling in the left eye for the past two and a half months following an accidental rice powder injury. He was earlier diagnosed to have tubercular scleritis and treated with oral steroids and anti-tubercular therapy. A repeat scleral biopsy on histopathological examination showed granulomatous inflammation. Microbiological investigations revealed the growth of Gram +ve branching filamentous bacilli in culture suggestive of Nocardia sp. PCR based DNA sequencing identified the bacterium as Nocardia cyriacigeorgica. The patient responded to topical fortified amikacin (2.5%), fortified cefuroxime, oral sulfamethoxazole and trimethoprim with complete healing of scleritis. Conclusions: Nocardia scleritis can be a diagnostic challenge for clinicians. Newer molecular techniques along with histopathological and microbiological investigations can clinch the diagnosis.