An unusual case of chronic eyelid infection associated with Staphylococcus aureus and Morganella morganii : A case report
- 1Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- 2College of Medicine, Chang Gung University, Kwei-shan, Taoyuan, Taiwan
- 3Department of Anatomic Pathology, Chang Gung Memorial Hospital, Keelung, Taiwan.
Abstract
Rationale:: Morganella morganii is an uncommon opportunistic pathogen, and eyelid infections attributable to this organism are exceptionally rare.
Patient concerns:: A 53-year-old male presented with persistent discharge and progressive structural changes of the left eyelid.
Diagnoses:: Microbiological analysis of conjunctival discharge initially revealed oxacillin-susceptible Staphylococcus aureus and M morganii. Intraoperative cultures subsequently yielded methicillin-resistant S aureus (MRSA) and M morganii. Histopathological examination demonstrated acute and chronic inflammatory changes with fistulous tract formation.
Interventions:: Initial empirical treatment included topical levofloxacin and tobramycin ophthalmic ointment, together with a brief course of oral amoxicillin/clavulanate. Based on subsequent culture and antimicrobial susceptibility findings, topical vancomycin was added to levofloxacin for 2 months, followed by intermittent topical antimicrobial therapy adjusted according to the clinical course. As conjunctival fistulae and chronic inflammation persisted despite extended medical treatment, surgical excision, limited debridement, and conjunctival wound closure were subsequently performed.
Outcomes:: Despite initial medical management, the patient developed multiple palpebral conjunctival openings and persistent fistulae over a 2-year period, with the discharge changing from purulent yellow secretions to thick, toothpaste-like material. Histopathological examination revealed acute and chronic inflammation with fistulous tract formation. Following surgical intervention, marked improvement was noted, including regression of the eyelid mass, closure of the fistulae, and resolution of discharge. At 1.5 years of postoperative follow-up, the eyelid remained stable without recurrence of fistulae or discharge.
Lessons:: This case highlights a chronic polymicrobial eyelid and conjunctival infection involving S aureus and M morganii, with methicillin-resistant S aureus isolated at the time of surgery. The findings suggest that M morganii may contribute to sustaining chronic periocular infection in susceptible hosts. In this patient, persistent infection complicated by fistula formation ultimately required surgical management after prolonged antimicrobial therapy failed to achieve resolution.
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BibTeX
@article{yang2026unusual,
title = {{An unusual case of chronic eyelid infection associated with Staphylococcus aureus and Morganella morganii : A case report}},
author = {Ju-Wen Yang and Liang-Che Chang},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051471},
url = {https://europepmc.org/article/PMC/PMC13727276},
note = {CC BY},
}
RIS
TY - JOUR
TI - An unusual case of chronic eyelid infection associated with Staphylococcus aureus and Morganella morganii : A case report
AU - Ju-Wen Yang
AU - Liang-Che Chang
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051471
UR - https://europepmc.org/article/PMC/PMC13727276
AB - Rationale:: Morganella morganii is an uncommon opportunistic pathogen, and eyelid infections attributable to this organism are exceptionally rare. Patient concerns:: A 53-year-old male presented with persistent discharge and progressive structural changes of the left eyelid. Diagnoses:: Microbiological analysis of conjunctival discharge initially revealed oxacillin-susceptible Staphylococcus aureus and M morganii. Intraoperative cultures subsequently yielded methicillin-resistant S aureus (MRSA) and M morganii. Histopathological examination demonstrated acute and chronic inflammatory changes with fistulous tract formation. Interventions:: Initial empirical treatment included topical levofloxacin and tobramycin ophthalmic ointment, together with a brief course of oral amoxicillin/clavulanate. Based on subsequent culture and antimicrobial susceptibility findings, topical vancomycin was added to levofloxacin for 2 months, followed by intermittent topical antimicrobial therapy adjusted according to the clinical course. As conjunctival fistulae and chronic inflammation persisted despite extended medical treatment, surgical excision, limited debridement, and conjunctival wound closure were subsequently performed. Outcomes:: Despite initial medical management, the patient developed multiple palpebral conjunctival openings and persistent fistulae over a 2-year period, with the discharge changing from purulent yellow secretions to thick, toothpaste-like material. Histopathological examination revealed acute and chronic inflammation with fistulous tract formation. Following surgical intervention, marked improvement was noted, including regression of the eyelid mass, closure of the fistulae, and resolution of discharge. At 1.5 years of postoperative follow-up, the eyelid remained stable without recurrence of fistulae or discharge. Lessons:: This case highlights a chronic polymicrobial eyelid and conjunctival infection involving S aureus and M morganii, with methicillin-resistant S aureus isolated at the time of surgery. The findings suggest that M morganii may contribute to sustaining chronic periocular infection in susceptible hosts. In this patient, persistent infection complicated by fistula formation ultimately required surgical management after prolonged antimicrobial therapy failed to achieve resolution.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -