Actinomyces Canaliculitis Complicated by Orbital Pyogenic Granuloma

J David Merriott,G Sanja Cypen,D Maria Estopinal,S Lilangi Ediriwickrema,H Amir Marvasti

doi:10.36959/587/595

Abstract

Abstract A 92 year-old woman with no significant past ocular history presented with a one-year history of bloody tears, pruritus, and an enlarging supero-medial orbital mass with extension through the right upper eyelid punctum. Magnetic resonance imaging of the orbits demonstrated a well-circumscribed, ring enhancing mass of the right anterior supero-medial orbit. Medial orbitotomy and removal of the orbital mass was performed, and histopathology revealed lymphoid proliferation surrounding a microbial infiltrate staining for gram-positive filamentous bacteria with sulfur granules. Overall, the findings were consistent with chronic canaliculitis secondary to Actinomyces species complicated by formation of an orbital pyogenic granuloma. She has had no recurrence of disease at five months of follow-up. To the authors' knowledge, this case is only the second report of pyogenic granuloma as a complication of Actinomyces canaliculitis and the first associated with an orbital mass.

Highlights

Actinomyces israelii, a filamentous, branching, grampositive, and predominantly anaerobic bacterium, is a common cause of canaliculitis
We present the case of a patient who developed a canalicular pyogenic granuloma with orbital extension in association with chronic Actinomyces canaliculitis
The overall findings were consistent with chronic canaliculitis secondary to Actinomyces species with an overlying pyogenic granuloma

Summary

Introduction

Actinomyces israelii, a filamentous, branching, grampositive, and predominantly anaerobic bacterium, is a common cause of canaliculitis. Pyogenic granulomas of the nasolacrimal system are rare, with data mostly limited to case reports and series [5,6,7], which suggest an association with prior placement of silicone punctal plugs [8]. To the authors’ knowledge, there has only been one reported case in the literature of a canalicular pyogenic granuloma attributed to Actinomyces infection [7].

Results

Conclusion