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Exposed Scleral Buckle Causing Atypical Mycobacterial Infection

Gur, Zvi M.D.*; Liu, Catherine Y. M.D., Ph.D.*; Korn, Bobby S. M.D., Ph.D.*,†; Kikkawa, Don O. M.D.*,†

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Ophthalmic Plastic and Reconstructive Surgery: May/June 2020 - Volume 36 - Issue 3 - p e83
doi: 10.1097/IOP.0000000000001458
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Mycobacterium fortuitum is a rare opportunistic infection. A 84-year-old woman presented with a 4-week history of purulent discharge from the right eye. Her past medical history includes diabetes mellitus and rheumatoid arthritis treated with abatacept (Orencia). On examination, she had right phthisis bulbi with an exposed and infected scleral buckle (Fig. A, arrow). Enucleation with removal of the exposed scleral buckle band was performed. Cultures revealed M. fortuitum. No implant was placed at the time of the enucleation.

Images obtained from patient with an infected scleral buckle. A, The arrow points to an exposed, infected scleral buckle. Purulent discharge is seen on the eyelids. B, Axial CT image shows enhancing amorphous material filling the right orbit cavity, consistent with extensive atypical mycobacterial soft tissue infection.

Postoperatively, the patient worsened despite therapy with bacteria-sensitive oral Ciprofloxacin. Clinically, the discharge improved but the pain and swelling persisted. CT imaging was obtained postoperatively and revealed that the entire right orbit was filled with an enhancing amorphous material consistent with extensive atypical mycobacterial soft tissue infection (Fig. B). Infectious disease consultation recommended an extended course of trimethoprim/sulfamethoxazole, cefoxitin, and amikacin. The patient recovered without complications. This report illustrates a rare case of extensive atypical mycobacterial infection of the orbit caused by exposed scleral buckle.

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