Orbital abscess caused by Exophiala dermatitidis following posterior subtenon injection of triamcinolone acetonide: a case report and a review of literature related to Exophiala eye infections

• Main Authors: Chiharu Iwahashi, Hiroshi Eguchi, Fumika Hotta, Mayu Uezumi, Miki Sawa, Masatomo Kimura, Takashi Yaguchi, Shunji Kusaka
• Format: Article
• Language: English
• Published: BMC 2020-08-01
• Series: BMC Infectious Diseases
• Subjects: Orbital abscess; Exophiala dermatitidis; Subtenon injection; Voriconazole; Pseudallescheria boydii/Scedosporium apiospermum complex
• Online Access: http://link.springer.com/article/10.1186/s12879-020-05294-y

Abstract Background Subtenon injection of triamcinolone acetonide (STTA) has been widely adopted in the clinical setting of ophthalmology and its infectious complications are rare. However, orbital abscess following STTA has been reported in seven cases. Furthermore, although eye infections due to Exophiala species are uncommon, there have been 19 cases to date. E. jeanselmei, E. phaeomuriformis, E. werneckii, and E. dermatitidis have been reported to cause human eye infections; however, to the best of our knowledge, orbital abscess caused by E. dermatitidis has not yet been reported. We describe the first documented case of fungal orbital abscess caused by E. dermatitidis following STTA. We also review the related literature of orbital abscess following STTA, as well as eye infections caused by the four Exophiala species. Case presentation The patient was a 69-year-old Japanese woman with diabetic mellitus. She had a macular oedema in her right eye, which occurred secondary to branch retinal vein occlusion. An orbital abscess caused by E. dermatitidis occurred 4 months after the second STTA for the macular oedema, which was successfully treated by a surgical debridement and systemic administration of voriconazole. Conclusions Our findings in the patient and from our literature survey caution ophthalmologists to the fact that STTA can cause fungal orbital infections, especially in diabetic patients. Furthermore, surgical treatment is one of the most important risk factors.