Background. Lacrimal infections by Actinomyces are rare and commonly misdiagnosed for long periods of time. They account for 2% of all lacrimal diseases. Case Report. We report a case of a 70-year-old female patient suffering from a para-canalicular abscess in the medial canthus of the left eye, beside the lower punctum lacrimale, resembling a chalazion. Purulence exited from the punctum lacrimale due to inflammation of the inferior canaliculus (canaliculitis). When pressure was applied to the mass, a second exit of purulence was also observed under the palpebral conjunctiva below the lacrimal caruncle. A surgical excision was performed followed by administration of local antibiotic therapy. The histopathological examination of the extracted mass revealed the existence of actinomycosis. Conclusion. Persistent or recurrent infections and lumps of the eyelids should be thoroughly investigated. Actinomyces as a causative agent should be considered. Differential diagnosis is broad and should include canaliculitis, chalazion, and multiple types of neoplasias. For this reason, in nonconclusive cases, a histopathological examination should be performed. 1. Introduction The word actinomycosis means “ray fungus.” ??These organisms may resemble fungi because of their filamentous semblance. Actinomycetes are a group of anaerobic, Gram-positive bacteria that vary phylogenetically, but are morphologically alike. The genus Actinomyces consists of a group of 42 species and 2 subspecies. The most common agent, concerning human diseases, among the Actinomyces species is A. israelii. However, there are less frequent species such as A. naeslundii, A. odontolyticus, A. viscosus, A. meyeri, and A. gerencseriae. Recently, new species were identified such as A. europaeus, A. neuii, A. radingae, A. graveenitzii, A. turicensis, A. cardiffensis, A. houstonesis, A. hongkongensis, and A. funkei. An infection due to Actinomyces may be related to damage of the normal physical barriers, such as the mucosal membranes in the mouth or the gastrointestinal tract. These infections can result in abscess formation and/or chronic progression [1]. Actinomyces may cause thoracic, abdominal, pelvic, central nervous system, musculoskeletal, or soft tissue infections. Ocular infections by Actinomyces are uncommon. We present a rare case of an actinomycosis beside the lower punctum lacrimale, resembling a recurrent chalazion. 2. Case Report A 70-year-old woman was referred to our clinic because of a tender, red, and painful swelling accompanied by purulent secretions in the left medial canthus,
References
[1]
D. C. Sullivan and S. W. Chapman, “Bacteria that masquerade as fungi: Actinomycosis/Nocardia,” Proceedings of the American Thoracic Society, vol. 7, no. 3, pp. 216–221, 2010.
[2]
F. Acevedo, R. Baudrand, L. M. Letelier, and P. Gaete, “Actinomycosis: a great pretender. Case reports of unusual presentations and a review of the literature,” International Journal of Infectious Diseases, vol. 12, no. 4, pp. 358–362, 2008.
[3]
J. R. Brown, “Human actinomycosis: a study of 181 subjects,” Human Pathology, vol. 4, pp. 319–330, 1973.
[4]
A. Von Graevenitz, “Actinomyces neuii: review of an unusual infectious agent,” Infection, vol. 39, no. 2, pp. 97–100, 2011.
[5]
V. Hall, “Actinomyces—gathering evidence of human colonization and infection,” Anaerobe, vol. 14, no. 1, pp. 1–7, 2008.
[6]
T. J. Roussel, E. R. Olson, T. Rice, D. Meisler, G. Hall, and D. Miller, “Chronic postoperative endophthalmitis associated with actinomyces species,” Archives of Ophthalmology, vol. 109, no. 1, pp. 60–62, 1991.
[7]
J. Pappalardo, G. A. Lee, and K. Whitehead, “Actinomycotic granule of the caruncle: a case report,” Ophthalmic Plastic and Reconstructive Surgery, vol. 27, no. 4, pp. e100–e102, 2011.
[8]
T. J. Sullivan, G. W. Aylward, and J. E. Wright, “Actinomycosis of the orbit,” British Journal of Ophthalmology, vol. 76, no. 8, pp. 505–506, 1992.
[9]
M. A. Vagarali, S. G. Karadesai, and M. S. Dandur, “Lacrimal canaliculitis due to actinomyces: a rare entity,” Indian Journal of Pathology and Microbiology, vol. 54, pp. 661–663, 2011.
[10]
D. Briscoe, E. Edelstein, I. Zacharopoulos et al., “Actinomyces canaliculitis: diagnosis of a masquerading disease,” Graefe's Archive for Clinical and Experimental Ophthalmology, vol. 242, no. 8, pp. 682–686, 2004.
[11]
T. Nizawa, T. Oshitari, R. Kimoto et al., “Early-stage mucinous sweat gland adenocarcinoma of eyelid,” Clinical Ophthalmology, vol. 5, no. 1, pp. 687–689, 2011.
[12]
S. Cavazza, G. L. Laffi, L. Lodi, and G. Collina, “Primary cutaneous adenoid cystic carcinoma of the upper lid: a case report and literature review,” International Ophthalmology, vol. 32, pp. 31–35, 2012.
[13]
S. B. Patil, S. M. Kale, S. Jaiswal, and N. Khare, “Schwannoma of upper eyelid: a rare differential diagnosis of eyelid swellings,” Indian Journal of Plastic Surgery, vol. 43, no. 2, pp. 213–215, 2010.
[14]
M. Meena, R. Mittal, and D. Saha, “Trichilemmal cyst of the eyelid: masquerading as recurrent chalazion,” Case Reports in Ophthalmological Medicine, vol. 2012, Article ID 261414, 3 pages, 2012.
[15]
E. Mohan, S. Kabra, P. Udhay, and H. Madhavan, “Intracanalicular antibiotics may obviate the need for surgical management of chronic suppurative canaliculitis,” Indian Journal of Ophthalmology, vol. 56, no. 4, pp. 338–340, 2008.