Preseptal cellulitis caused by Mycobacterium intracellulare

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Preseptal cellulitis, an infection of the eyelid and surrounding tissues, typically responds to broad-spectrum antibiotics.
• Ocular infections caused by non-tuberculous mycobacteria are uncommon but can present diagnostic challenges.

Observation:

• A 56-year-old woman developed persistent right eyelid erythema, induration, and tenderness post-chalazion removal.
• Initial treatment with broad-spectrum antibiotics for three weeks proved ineffective.

Findings:

• Incisional biopsy revealed granulomatous inflammation and acid-fast bacilli.
• Culture identified Mycobacterium intracellulare, exhibiting resistance to all administered antimicrobials.
• Discontinuation of antimicrobial therapy led to spontaneous resolution of the infection over 15 months.

Implications:

• This case suggests that Mycobacterium intracellulare should be considered in refractory preseptal cellulitis, especially after procedures.
• The resolution upon antimicrobial cessation indicates a potential need for tailored, or even conservative, management in specific mycobacterial infections.
• Further research into the optimal treatment strategies for Mycobacterium intracellulare-induced ocular infections is warranted.