Photo Quiz: A 9-Year-Old Girl with Eye Swelling and Drainage

Abstract

A previously well 9-year-old girl presented with excess tearing and mild discomfort to the left side of her nose. She was not otherwise ill, and there was no history of trauma, sinusitis, or eye disease. There was no involvement of the contralateral eye. She was a dancer who frequently used eye makeup. She had no response to a variety of oral and topical antibiotics. She was diagnosed with chronic dacryocystitis and nasal lacrimal duct obstruction. She underwent surgical exploration and biopsy, which showed granulomatous inflammation and hyphal elements. No cultures were obtained. Postoperatively, a pustule developed at the incision site, and her eye continued to water. She had no fever and otherwise felt well. She was again treated with oral and topical antibacterial agents as well as oral fluconazole, without response. A computed tomography scan demonstrated orbital abscess. She underwent surgical exploration and debridement with drainage of purulence from the medial wall of the orbit. Histological examination again showed granulomatous inflammation with hyphae, which were not prominently septated. The organism initially grew on Sabouraud's agar. Subculture to Czapek Dox agar produced the structures seen in Fig. 1 after 5 weeks of incubation.

Saksenaea infection masquerading as a brain tumor in an immunocompetent child

“…Two cases of rhino‐orbital S. erythrospora infections have been reported, including a case of rhinosinusitis and orbital cellulitis in an immunocompetent female requiring orbital exenteration and a case of orbital infection in an immunocompetent child with congenital nasolacrimal duct obstruction, both from India and both who recovered . There has been only one case of S. oblongispora infection, associated with dacrocystitis and orbital abscess in a child presenting with no known risk factors although she frequently used eye makeup . Our patient often rode on dirt bikes with his father and there was road construction nearby where they lived.…”

Early trends of secondary acquired nasolacrimal duct obstruction in COVID-19 associated sino-orbital mucormycosis: SALDO update study (SUP) – Paper IV

“…The infection resolved after prolonged therapy with Posaconazole. 13 , 14 Concomitant aspergillus and mucormycosis infection causing acute dacryocystitis and spreading to the orbit was reported and needed extensive debridement followed by medical management with liposomal Amphotericin-B and voriconazole. 15 …”