Topic outline

  • Grand Rounds

    A patient underwent bilateral medial rectus recession for a history of infantile esotropia. Ten days prior to the surgery, she developed a skin lesion on her forearm and was placed on clindamycin by her primary care physician (PCP) due to a history of previous MRSA infection that was sensitive to clindamycin. on day seven post-operatively, she presented with asymmetrical nasal swelling in the right eye more than the left without purulent discharge or eyelid swelling. A ten day course of oral Clindamycin was prescribed , and the nasal lesions completely improved. However, the right nasal swelling recurred four days after stopping clindamycin, so she was placed on topical neomycin/polymyxin B/dexamethasone for five days with no improvement. A surgical exploration and excision of the nasal mass four weeks after the medial rectus recession was performed. The tissue was submitted to the pathology lab, and cultures were taken from the mass and the conjunctival surface. Pathology showed a pyogenic granuloma with rare gram-positive cocci, and culture results confirmed a heavy growth of Staphylococcus aureus infection. Sensitivity results confirmed MRSA resistant to clindamycin and sensitive to vancomycin and trimethoprim-sulfamethoxazole. The patient was placed on oral Bactrim and received topical and sub-conjunctival vancomycin. After completing the antibiotic course, the patient was doing well with complete resolution of the nasal mass.

    Presentation Date: 05/30/2024
    Issue Date: 06/21/2024