Orbital Actinomycosis Associated with Painful Ophthalmoplegia

Abstract

Purpose: To evaluate a case of orbital actinomycosis presenting as Tolosa-Hunt syndrome in a patient with a history of carcinomas of the kidney and breast. Methods: A woman with ingravescent painful ophthalmoplegia was brought to our observation. Brain and orbital and total body CT scans showed the presence of two orbital neoformations and a miliary pattern of dissemination in the lung. The initial diagnosis, which pointed to secondary localisations of the previous kidney and breast tumours, was changed to orbital and pulmonary actinomycosis following microbiological analysis of lung biopsy samples. Results: Prolonged antibiotic therapy with synthetic penicillin completely resolved the case. Conclusions: Actinomycosis is a very rare infection that may also affect the orbit and its association with a pulmonary dissemination is highly unusual. It is important to consider this type of infection among the causes of painful ophthalmoplegia.

A rare and an unusually delayed presentation of orbital actinomycosis following avulsion injury of the scalp

“…[1–4] Actinomyces are filamentous, branching gram-positive bacilli normally inhabiting the oral cavity. They exhibit low pathogenicity and require mucosal barrier disruption to cause disease.…”

“…[6] Although patients have presented varyingly with acute orbital abscess and painful ophthalmoplegia,[34] the usual presentation is as a painless proptosis with restricted extra-ocular movements, often mimicking a malignancy. In our patient, it is likely that the intra-orbital extent of the lesion was insufficient to produce globe displacement.…”

“…[1–4] The source of infection may be either from the oral cavity or paranasal sinuses or following trauma. [56] We report a case of this uncommon infection, which presented one year after avulsion injury of the scalp sustained in a road traffic accident.…”

Delayed-onset Actinomyces Keratitis After Laser In situ Keratomileusis

“…2 Herein, we describe a case of LASIK-associated Actinomyces israelii keratitis. Although this organism has been described as a microbial pathogen in conjunctivitis, keratitis, blepharitis, 3,4 canaliculitis, 5,6 dacryocystitis, 7 and orbital cellulites, 8 to the best of our knowledge, this is the first case report of keratitis after LASIK caused by Actinomyces species.…”

Periocular infection

“…Pagliani, Campi and Cavallini [34 ] present a cautionary tale regarding the presumptive diagnosis of THS. A 53-year-old woman presented with an explosive onset of orbital pain associated with diplopia.…”