ePoster listing and sessions

Topic: ESOPRS 2021 ePoster sessions
Time: Sep 17, 2021 16:00 Amsterdam, Berlin, Rome, Stockholm, Vienna, 15:00 London

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Peri-ocular Mycobacterium infection post botulinum toxin injection 

Author: Manvi Sobti
ePoster Number: 271


Purpose

To highlight this rare periocular infection and successful multi-disciplinary management with a photo series 


Methods

Case report 


Results

An 83-year-old patient with a history of treated breast cancer and active systemic immunosuppression for rheumatoid arthritis and Crohn’s disease, presented with a 1 cm nodular lesion in the lateral canthal area three months following botulinum toxin injections for hemifacial spasm. Excisional biopsy demonstrated mycobacterial infection and PCR analysis of the histopathology sample was suggestive of non-tubercular mycobacteria.  Whole genomic sequencing identified the species as Mycobacterium Fortuitum. The same organism was identified on asymptomatic sputum analysis, with normal chest CT imaging. Despite repeated complete excision of the lesion, the lesion rapidly regrew to double the original size within eight weeks and orbital involvement was the concern. Empirical treatment with cotrimoxazole and doxycycline was initiated, subsequently modified to ciprofloxacin and doxycycline following antibiotic sensitivities. Complete resolution was seen with seven weeks of treatment. Treatment was planned for four
months but in view of complete resolution of symptoms and significant gastrointestinal and tendonitis side effects the treatment had to be discontinued. However, the patient remains disease-free two months after cessation of all the
antibiotic therapy.   
 


Conclusion

Peri-ocular infections with mycobacterium fortuitum are extremely rare and involvement following botulinum toxin injections has not been reported before. The key factors in successful management include TB PCR from the histopathology specimens alongside genomic analysis and antibiotic sensitivity tests. These allow individually tailored treatment strategies.Multidisciplinary team management with Microbiology, TB specialists remain criticalin successful disease management.


Additional Authors

First nameLast nameBase Hospital / Institution
RichardScawnChelsea and Westminster Hospital

Abstract ID: 21-174