Disseminated orbital actinomycetoma: A case report

Abstract

Mycetoma is a chronic granulomatous infection. Lower extremities are commonly involved. A 20-year-old male came with complaints of multiple sinuses on scalp, left eyelid swelling with a sinus and dystopia, since one year. On examination there was relative proptosis in left eye of 2 mm. Computed tomography scan showed soft tissue swelling of the pre-septal area of the left upper eyelid with orbital involvement. Magnetic resonance imaging showed increased left orbital volume and evident dystopia. Microbiology testing of the erosive scalp and lid lesions showed genus Nocardia, suggestive of actinomycetoma. This case is presented as it shows an unusual involvement of the orbit.

Actinomycetoma of the scalp after a car accident

“…In the literature, we found 13 cases of mycetoma of the scalp (Tables 1 and 2): [5][6][7][8][9][10][11][12][13][14][15][16][17] nine caused by aerobic actinomycetes, 5,6,8,9,11,13,[15][16][17] two by a combination of actinomycetes and eumycetes, 10,14 and the remaining two by eumycetes alone. 7,12 None of the actinomycetoma cases cited were treated with amikacin and SXT.…”

Nocardia Infections of the Face and Neck

“…Facial Nocardia infections have also been described in adults without a history of trauma [22,32]. Nonetheless, the majority of cases of Nocardia affecting the neck and face in immunocompetent adults have been associated with local trauma: from thorns, abrasions following falls to the ground, being hit by a shovel, and motor vehicle accidents leading to facial injuries (Table 1) [5,7,8,11,12,28,29,31,36].…”

“…In one patient, a mycetoma involving the periorbital tissues resulted in proptosis and restriction of extraocular movements [36]. As with other forms of primary skin infection, extension of infection from the face to the surrounding soft tissue and bone has been described [28].…”

“…Mycetomas of the face may also occur [4], and may not always be preceded by a clear history of trauma [22,31,36]. In one patient, a mycetoma involving the periorbital tissues resulted in proptosis and restriction of extraocular movements [36].…”

Actinomycotic lid abscess: a rare presentation

“…Maintenance phase consisted of Amoxicillin/ Doxycycline and Co-trimoxazole for 2 to 5 months after complete healing. 9,10 "Welsh Regime consists of simultaneous administration of IV Amikacin (15 mg/ Kg/ day) in two divided doses for three weeks along with Oral Co-trimoxazole for five weeks with intervening two week wash out period for Amikacin. 8,11 In Modified Welsh regime daily oral Rifampicin (10 mg/ Kg/day) is added to Welsh Regime, with a maintenance phase of Cotrimoxazole for three months.…”