Breaking the mold of orbital cellulitis.
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.
Peden
Marc C
MC
Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA.
Neelakantan
Arvind
A
Orlando
Christine
C
Khan
Shahab A
SA
Lessner
Alan
A
Bhatti
M Tariq
MT
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
D000935:Antifungal Agents