title: Breaking the mold of orbital cellulitis.
abstract: A 52-year-old, immune-suppressed man presented with painful proptosis. Orbital imaging revealed enhancement of his right inferior rectus muscle and mild ethmoidal sinus disease. Sinus washings and turbinectomy demonstrated Curvularia. Despite aggressive intravenous antimicrobials, the patient remained febrile. Repeat imaging demonstrated a well-defined intramuscular abscess without contiguous orbital or paranasal involvement. Following surgical drainage, the patient improved. Cultures of the material expressed from the abscess confirmed a co-infection with Fusarium. Although rare, fungal abscess of the extraocular muscle should be considered in patients (particularly if immunosuppressed) with extraocular muscle enlargement resistant to conventional antimicrobial therapy. Prompt diagnosis and treatment could potentially prevent further serious morbidity or mortality.
authors.affiliation: Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Peden
authors.forename: Arvind
authors.initials: A
authors.lastname: Neelakantan
authors.forename: Christine
authors.initials: C
authors.lastname: Orlando
authors.forename: Shahab A
authors.initials: SA
authors.lastname: Khan
authors.forename: Alan
authors.initials: A
authors.lastname: Lessner
authors.forename: M Tariq
authors.initials: MT
authors.lastname: Bhatti
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D000935:Antifungal Agents / Q000627:therapeutic use; D001203:Ascomycota / Q000302:isolation & purification*; D003131:Combined Modality Therapy; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005670:Fusarium / Q000302:isolation & purification*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D009801:Oculomotor Muscles / Q000473:pathology; D054517:Orbital Cellulitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents