Aspergillus mycetoma in a secondary hydroxyapatite orbital implant - A case report and literature review

Objective: The authors describe the first case report of a fungal abscess w ithin a hydroxyapatite orbital implant in a patient who had undergone strai ghtforward secondary hydroxyapatite implant surgery. Design: Case report and literature review. Intervention: Four months postoperatively after pegging and 17 months after original implant placement, chronic discharge and socket irritation became evident. Recurrent pyogenic granulomas were a problem, but no obvious area of dehiscence was present over the implant. The peg and sleeve were remove d 31 months after pegging (44 months after original placement of the implan t), The pain and discharge did not resolve, and the entire hydroxyapatite o rbital implant was removed 45 months after sleeve placement and 58 months a fter initial implant placement. The pain and discharge settled rapidly. Main Outcome Measures: Cultures and histopathology, Results: Results of bacterial cultures were negative. Results of histopatho logic examination of the implant disclosed intertrabecular spaces with mult iple clusters of organisms consistent with Aspergillus. Conclusions: Persistent orbital discomfort, discharge, and pyogenic granulo mas after hydroxyapatite implantation should cause concern regarding potent ial implant infection. The authors have now shown that this implant infecti on could be bacterial or fungal in nature, This is essentially a new form o f orbital Aspergillus, that of a chronic infection limited to a hydroxyapat ite implant.