Nontuberculous mycobacterial infection after frontalis sling surgery using silicone rod

Batriti Walang,Suryasnata Rath,Savitri Sharma

doi:10.1007/s12348-012-0073-y

Abstract

PurposeThe purpose of this study is to report a case of nontuberculous mycobacterial infection after frontalis sling surgery.MethodA 65-year-old man presented with bilateral painful, erythematous lesions in the brow and upper eyelids. He had a history of frontalis sling surgery for myopathic ptosis 2 years back and all lesions were found localized to the tract of the silicone rod used in the previous frontalis sling surgery.ResultIncision and drainage of the lesions with microbiological analysis revealed significant growth of coagulase negative staphylococcus and Mycobacterium fortuitum. Sensitivity-based antibiotic treatment with intravenous amikacin was started, but poor response necessitated eventual explantation of both silicone rods for relief of symptoms. Culture of the explanted rods revealed similar results of M. fortuitum infection. Five months after the acute presentation, the patient is asymptomatic.ConclusionNontuberculous mycobacterial infection may be a delayed onset complication in frontalis sling surgery using silicone rods.

Highlights

Frontalis sling surgery is the treatment option for myopathic blepharoptosis with poor levator muscle action [1]
Infections associated with the silicone rod after frontalis sling surgery have been reported [2]
Nontuberculous mycobacterial infections in the periocular region are rare and are usually caused by organisms belonging to Runyon group IV including Mycobacterium chelonae and Mycobacterium fortuitum [3]

Summary

Introduction

Frontalis sling surgery is the treatment option for myopathic blepharoptosis with poor levator muscle action [1]. Infections associated with the silicone rod after frontalis sling surgery have been reported [2]. Nontuberculous mycobacterial infections in the periocular region are rare and are usually caused by organisms belonging to Runyon group IV including Mycobacterium chelonae and Mycobacterium fortuitum [3]. Chang et al reported six cases of nontuberculous mycobacterial infection and found an association with nasolacrimal duct obstruction, implantation of foreign body, history of recent surgery, and immunosuppression [3]. Mauriello found implantation of a foreign body in 5 out 13 patients of nontuberculous mycobacterial infections of the periocular region [4]. We report a rare case of nontuberculous mycobacterial infection of the silicone rod after frontalis sling surgery

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