Periocular atypical mycobacterial infections

Objective: To examine the clinical characteristics and management of perioc ular infections caused by atypical mycobacteria. Design: Retrospective, noncomparative case series. Participants: Six patients were identified with periocular atypical mycobac terial infections: four with Mycobacterium chelonae and two with Mycobacter ium fortuitum. Intervention: The treatment of these infections included removal of the for eign bodies with debridement of the lesions. Specimens were sent for histop athologic examination, routine cultures, and fresh tissue for culture after homogenization. Main Outcome Measures: A retrospective review of culture-proven atypical my cobacterial infections involving the periocular tissues was performed. Char ts were reviewed for age, gender, infectious organism, medical history, sur gical history, presenting symptoms, clinical features, and treatment. Results: Four associations with infection were identified in these patients : immunosuppression, nasolacrimal duct obstruction, the presence of a forei gn body, and a history of recent surgery. All six of the patients had at le ast one of these associations and five of the patients had at least two, Cl inical characteristics that may distinguish atypical mycobacterial infectio ns from acute bacterial infections include subacute presentation, firm nodu lar lesions, mild erythema, mild tenderness, and minimal purulent discharge . All patients had resolution of their infections after debridement and sev eral weeks of systemic antibiotic therapy guided by susceptibility testing. Conclusions: Periocular atypical mycobacterial infections are uncommon. The clinical history and examination can raise the suspicion of this infection by revealing the clinical characteristics of these infections. Treatment i ncludes removal of foreign bodies, debridement, and long-term systemic anti biotic therapy.