ATYPICAL MYCOBACTERIAL INFECTION OF THE ORBIT

Purpose: To describe the clinical presentation and successful manageme nt of an orbital infection caused by Mycobacterium abscessus, a former ly unrecognized cause of orbital disease after penetrating trauma. Met hods: An orbital infection due to M. abscessus is described, and previ ously reported ocular and extraophthalmic infections caused by M, absc essus are reviewed. Results: A 5-year-old boy had acute, painless visu al loss shortly after being struck in his left lower eyelid with a fis hing rod. Radiologic evaluation established a mass in the orbital apex . Initial biopsy and cultures of the apex mass were negative; however, additional orbital exploration and cultures demonstrated M, abscessus to be the causative organism. The orbital infection was treated succe ssfully with long-term oral clarithromycin, Review of the literature o n ocular/adnexal and soft tissue infections caused by atypical mycobac teria shows characteristic clinical and histopathologic features, Conc lusions: To the authors' knowledge, only seven patients with atypical mycobacterial infections of the ocular adnexa have been reported, The patient reported in the current study illustrates the difficulty in es tablishing the preoperative diagnosis of atypical mycobacterial infect ions of the orbit. A chronic draining wound or a localized orbital abs cess, after penetrating trauma, should alert the physician to the poss ibility of an M. abscessus infection, Clarithromycin, an oral macrolid e antibiotic, appears to be the most effective medical therapy for the se patients.