Mycobacterium chelonae is a rapidly growing nontuberculous Mycobacterium and an uncommon cause of aggressive, treatment-resistant ocular and periocular
infection. This is the first known case report of a woman who developed unilateral M. chelonae
dacryocystitis after undergoing endoscopic sinus surgery and right endoscopic
dacryocystorhinostomy (DCR) with Crawford
stent placement. We describe our findings and effective methods to manage the
infection. Three weeks after undergoing DCR, the patient acutely developed symptoms consistent with
dacryocystitis. The patient was treated with broad-spectrum
antibiotics followed by incision and drainage of the dacryocystocele
abscess, with initial cultures showing no organisms. With continued signs of
infection, the Crawford
stent was later removed. Cultures eventually grew M. chelonae and the patient was treated with 4 months of
antibiotic therapy. While receiving
antibiotics, the patient developed three
abscesses along the inferior lid requiring excision. After 21 months, the patient remains free of
infection and has not experienced any other complications. This case serves as a reminder to consider M. chelonae as a potential cause of periocular
infection, which may be more likely to occur postoperatively with indwelling devices, as well as in patients with sinonasal issues requiring nasal irrigations. This organism can be difficult to treat because of multidrug resistance and biofilm production. Recommended
therapy includes surgical
debridement, removal of any implanted devices, and a two-
drug antibiotic regimen for at least 4 months.