Mixed Nocardia cyriacigeorgica and Staphylococcus aureus Infection in the Periocular Skin and Orbit in an Immunocompetent Adult

Abstract

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.

KEYWORDS::

• Periocular cutaneous and orbit
• Mixed Nocardia cyriacigeorgica
• Staphylococcus aureus infection

ACKNOWLEDGMENTS

Financial support is acknowledged from the Hyderabad Eye Research Foundation, Hyderabad, India.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.