Mixed Nocardia cyriacigeorgica and Staphylococcus aureus infection in the periocular skin and orbit in an immunocompetent adult.
A 32-year-old non-alcoholic, immunocompetent male with history of prior trauma presented with pain and protrusion of the left eye of 8 months' duration. A firm nontender mass could be palpated in the superomedial orbit and the periocular skin had multiple discharging nodules. Computed tomography of the orbit showed an ill-defined lesion in the left orbit with preseptal soft tissue thickening, lacrimal gland infiltration and a moth eaten appearance of the left orbital roof. Tissue sampling from discharging cutaneous sinuses grew confluent colonies of Staphylococcus aureus and Nocardia cyriacigeorgica (16S rRNA gene sequencing; GQ376180). Histopathological examination showed mixed inflammatory infiltrates and eosinophilic granules showing Splendore-Hoeppli phenomenon. Despite an early response to treatment with intravenous amikacin, reactivation of left orbital inflammation led to eventual loss of vision. A prolonged treatment course with intravenous amikacin and oral trimethoprim-sulfamethoxazole over a period of 1 year showed clinical resolution with periocular scarring, hypoglobus, and sensory exotropia.
L. V. Prasad Eye Institute, Bhubaneswar , India. drsuryasnata@gmail.com
Suryasnata
S
Rath
Savitri
S
Sharma
Samir
S
Mohapatra
Aravind
A
Roy
Geeta K
GK
Vemuganti
Praveen
P
Balne
Ashok
A
Reddy
D000328:Adult; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D009617:Nocardia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D009916:Orbital Diseases / Q000188:drug therapy / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin