Necrotizing <b><i>Streptococcus pyogene</i></b>s Infiltrating Conjunctiva and Tenon’s Capsule: A Case Report

Abstract

We report a case of a patient with necrotizing infection of the conjunctiva and Tenon’s capsule caused by &lt;i&gt;Streptococcus pyogenes&lt;/i&gt;, a rare and atypical ophthalmologic condition. A 50-years-old male patient with acute red-eye, purulent discharge, and pain diagnosed with post-septal cellulitis presented with a yellowish and dense membrane covering the ocular surface with necrotic Tenon’s capsule. Patient was hospitalized, and intravenous antibiotics were initiated (ceftriaxone and clindamycin). Topical antibiotics and corticosteroids were also administered, and the infection was eradicated in 2 weeks. Ancillary exams excluded rheumatologic involvement. Conjunctival culture confirmed &lt;i&gt;Streptococcus pyogenes&lt;/i&gt; growth. Tenon’s biopsy revealed unspecific acute inflammatory necrosis. This is an uncommon condition in daily ophthalmological clinic. Literature review reported 3 cases associated with previous ocular surgery.

Progressive Necrotizing Ocular Surface Disease, Despite Immunosuppression

“…[1][2][3][4][5] Other causes for chronic granulomatous ocular surface disease include sarcoidosis, foreign bodies, chronic topical medication, and many infective agents-including Streptococcus pyogenes, Treponema pallidum, Mycobacterium leprae and other atypical mycobacteria, Bartonella henselae, chlamydia, rickettsia, fungi, and parasites. 1,2,[6][7][8] Necrotizing conjunctivitis is more common with some viruses (such as human monkeypox), S. Pyogenes, Bartonella henselae, typical and atypical mycobacteria, and some foreign bodies. 1,2,[6][7][8] This patient had 2 years of slowly progressive disease before a diagnosis was finally established, emphasizing the need for repeated biopsies in the context of recalcitrant or atypical disease.…”

“…1,2,[6][7][8] Necrotizing conjunctivitis is more common with some viruses (such as human monkeypox), S. Pyogenes, Bartonella henselae, typical and atypical mycobacteria, and some foreign bodies. 1,2,[6][7][8] This patient had 2 years of slowly progressive disease before a diagnosis was finally established, emphasizing the need for repeated biopsies in the context of recalcitrant or atypical disease. Mycobacteria should always be considered as a cause for unusual or severe periocular granulomatous inflammation and an accurate history obtained; interferon-gamma release assays have about 80%-95% sensitivity, 9,10 and hence a negative result does not exclude active or latent tuberculosis.…”

“…1,2,6–8 Necrotizing conjunctivitis is more common with some viruses (such as human monkeypox), S. Pyogenes, Bartonella henselae, typical and atypical mycobacteria, and some foreign bodies. 1,2,6–8…”