Orbital Cellulitis Associated with Scleral Buckle Infection Caused by Macrolide-Resistant <i>Mycobacterium abscessus</i> Complex: A Case Report and Literature Review.

Abstract

Ocular infections following scleral buckle placement for retinal detachment, though rare, can lead to significant complications such as orbital cellulitis and endophthalmitis. While <i>Mycobacterium chelonae</i> and <i>M. fortuitum</i> complexes were historically the most common nontuberculous mycobacteria (NTM) associated with these infections, cases caused by <i>Mycobacterium abscessus</i> complex (MABC) are rising, posing therapeutic challenges. We report a case of <i>M. abscessus</i> subsp. <i>abscessus</i> (MAB) scleral buckle infection with orbital cellulitis in a 69-year-old male, successfully managed with buckle removal and prolonged systemic antimicrobial therapy. The isolate demonstrated multidrug resistance, including phenotypic macrolide resistance, despite no genotypic mutations detected in <i>erm(41)</i> or <i>rrl</i>. Treatment with imipenem, amikacin, tigecycline, clofazimine, and azithromycin resolved the infection. A review identified 12 cases of MABC scleral buckle infections, underscoring the need for comprehensive surgical and pharmacologic approaches. This case highlights the importance of molecular diagnostics, phenotypic testing, and species-level identification in managing these challenging infections.