J Korean Diabetes.  2016 Sep;17(3):219-223. 10.4093/jkd.2016.17.3.219.

A Case of Actinomycosis of an Orbital Subperiosteal Abscess in a Patient with Type 2 Diabetes Mellitus

• Park JE
• Kang JB
• Park HY
• Ahn JY
• Shin JH
• Lee KH
• Cho IJ
• Hwang YC
• Ahn KJ
• Chung HY
• Jeong IK

• KMID: 2354288
• DOI: http://doi.org/10.4093/jkd.2016.17.3.219

Abstract

Orbital and paranasal actinomycosis have not been commonly reported. We report a case of this uncommon infection, which was improved after endonasal endoscopic drainage and antibiotics. A 53-year-old woman with type 2 diabetes mellitus complained of inability to lift her right upper eyelid and painful swelling over the preceding two days. Broad-spectrum antibiotics did not resolve her lesion. In ophthalmic examination, decreased visual acuity, upper and medial gaze limitation, and a relative afferent pupillary defect of her right eye were observed. Computed tomography of the orbit showed aggravated orbital cellulitis, preseptal cellulitis, subperiosteal abscess, and maxillary and ethmoid sinusitis. After endonasal endoscopic drainage and systemic antibiotics, her clinical symptoms dramatically improved. Microbiological analysis of the maxillary excisional biopsy showed Actinomycosis. This case is of interest due to the rare orbital presentation of actinomycosis infection and the importance of appropriate surgical drainage and long-term antibiotics treatment in such cases. Because delayed diagnosis and treatment of rhino-orbital actinomycosis can cause permanent vision loss or intracranial abscess, it requires careful clinical attention.

Keyword

Actinomycosis; Orbital cellulitis; Type 2 diabetes mellitus

MeSH Terms

Abscess*
Actinomycosis*
Anti-Bacterial Agents
Biopsy
Cellulitis
Delayed Diagnosis
Diabetes Mellitus, Type 2*
Drainage
Ethmoid Sinus
Ethmoid Sinusitis
Eyelids
Female
Humans
Middle Aged
Orbit*
Orbital Cellulitis
Pupil Disorders
Visual Acuity
Anti-Bacterial Agents

Figure

• 

  Fig. 1. Right orbital ptosis and reddish swelling of the upper lid on presentation due to right orbital cellulitis.

• 

  Fig. 2. Orbital computed tomography scan showed preseptal cellulitis, ethmoidal sinusitis, maxillary sinusitis, and a subperiosteal abscess on the right side.

• 

  Fig. 3. (A) Microbiological analysis of the nasal abscess showed a small cluster of Actinomycosis with surrounding mixed inflammation and Splendore-Hoeppli phenomenon (arrowheads), (B) filamentous Actinomyces (arrows). (A) H&E, ×100, (B) Gomori Methenamine silver stain, ×400.

Reference

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