Recurrent Rhodococcus gordoniae eyelid infection after combined septoplasty and blepharoplasty

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Rhodococcus species are uncommon human pathogens, with Rhodococcus equi typically causing pneumonia in foals.
• Human infections usually affect immunocompromised individuals; infections in immunocompetent hosts are rare.
• Non-Rhodococcus equi rhodococcal infections are seldom reported, often linked to traumatic inoculation.

Observation:

• A 44-year-old immunocompetent woman developed a recurrent granulomatous lower eyelid infection.
• The infection occurred after a combined intranasal and lower blepharoplasty procedure.
• The causative agent was identified as Rhodococcus gordoniae, a non-equi Rhodococcus species.

Findings:

• This is the first reported case of Rhodococcus gordoniae infection specifically affecting the eyelids.
• Literature review identified only 10 non-R. equi rhodococcal infections, with 5 involving the eye or ocular adnexa.
• Accurate identification of Rhodococcus species can be challenging for clinical laboratories, as demonstrated by initial misidentification in this case.

Implications:

• Highlights the potential for rare Rhodococcus species to cause opportunistic infections in ocular adnexa, even in immunocompetent individuals.
• Underscores the importance of specialized laboratory identification for accurate diagnosis of Rhodococcus infections.
• Suggests that multidrug resistance in Rhodococcus species may complicate treatment, potentially leading to prolonged and difficult therapeutic courses.