Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA)--a rare cause of fulminant orbital cellulitis.
We report a 55-year-old female patient who developed a severe right-sided orbital cellulitis. Past history was significant for a boil on the right upper eyelid 2 days prior. Visual acuity at presentation was perception of light with inaccurate projection. Orbital computed tomography (CT) scan and routine blood investigations, including blood culture, urine examination, and urine culture, were performed. CT scan showed a superonasal orbital mass suggestive of an abscess. Abscess drainage followed by pus culture, sensitivity, and pulsed-field gel electrophoresis revealed community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) resistant to all antibiotics except vancomycin, cotrimoxazole, and amikacin. The condition completely resolved post antibiotic and steroid therapy. At 3 months follow-up, the vision in the right eye was 6/9. We report this case to highlight CAMRSA as a rare but virulent cause of orbital cellulitis; empiric antibiotic therapy should include coverage for CAMRSA until susceptibilities come back.
Department of Ophthalmic and Facial Plastic Surgery, Orbital Diseases, and Ocular Oncology, Aditya Jyot Eye Hospital, Mumbai, India. debraj shome@yahoo.com
Debraj
D
Shome
Vandana
V
Jain
Sundaram
S
Natarajan
Shyam
S
Agrawal
Kiran
K
Shah
D000038:Abscess / Q000175:diagnosis* / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016106:Methicillin Resistance; D008875:Middle Aged; D054517:Orbital Cellulitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D035583:Rare Diseases; D018570:Risk Assessment; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents