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Pediatric coccidioidal orbital granuloma
Cassiana E Bittencourt1, Onyinye Okezie2, Khalid Tawansy3
1Department of Pathology and Laboratory Medicine, University of California Irvine, School of Medicine, Irvine, CA, USA.
Insights
Orbital coccidioidomycosis, a rare fungal infection, was diagnosed in an 11-month-old boy. Prompt surgical drainage and antifungal treatment led to complete recovery without systemic involvement.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Orbital infections can present with varied symptoms.
- Coccidioidomycosis is a fungal infection endemic to specific regions.
Observation:
- An 11-month-old male presented with orbital swelling, erythema, and pain.
- Initial conservative treatment and antibiotics were ineffective.
- Ultrasound revealed an orbital mass, leading to surgical drainage.
Findings:
- Culture, histopathology, and serology confirmed Coccidioides spp. infection.
- The patient experienced complete symptom resolution after surgical intervention and oral fluconazole.
Implications:
- Orbital coccidioidomycosis can occur as a primary manifestation of infection.
- Early consideration of fungal etiology is crucial in endemic areas, even after minor trauma.
Purpose:
To report a case of orbital coccidiomycosis in an otherwise healthy 11-month-old male.
Observations:
An 11-month-old male presented to his pediatrician with parental complaints of swelling, erythema, and pain of the right orbit that increased over ten days in the absence of constitutional symptoms. The child's parents reported an earlier fall onto a carpeted floor. After four weeks of conservative treatment and a course of oral cephalexin, he developed a fever, increased erythema, and palpable enlargement of a mass posterior to the lower eyelid. Ultrasound revealed an encysted mass in the inferior orbit, suggestive of an abscess. Urgent ophthalmic referral led to incision and drainage via orbitotomy. Culture, histopathology, and serological testing were positive for Coccidioides spp.. Blood studies revealed mild anemia and thrombocytosis. There was complete resolution of symptoms after surgical drainage and several weeks of oral fluconazole.
Conclusion And Importance:
We describe a patient with orbital coccidiomycosis without apparent systemic involvement, following what was most likely an unrelated minor trauma. Despite being rare, orbital coccidiomycosis should be considered as a primary manifestation of infection when ocular inflammation is encountered, especially in endemic regions.
