Necrotizing Pseudomonas Infection of the Ocular Adnexa in an Infant With Leukocyte Adhesion Defect

Necrotizing Pseudomonas Infection of the Ocular Adnexa in an Infant With Leukocyte Adhesion Defect To the Editors: A 14-day-old male neonate presented with left congenital nasolacrimal duct obstruction and was prescribed topical antibiotics. One week later, he developed an ulcer over the medial canthus of the left eye. Cultures from the wound grew Pseudomonas aeruginosa. Intravenous amikacin and metronidazole were commenced. The ulcerative lesion progressively destroyed the medial upper and lower eyelids, medial canthus, and part of the left lacrimal drainage system, and extended through the maxillary antrum to cause a hard-palate perforation (Fig. 1). Intravenous meropenem was added, and topical gentamicin was increased to every 2 hours. Artificial tears and lid taping were advised. Complete blood count revealed leukocytosis. Flow cytometry analysis of the 2 integrin revealed absent surface membrane expression of CD18 on polymorphonuclear leukocytes, confirming the diagnosis of leukocyte adhesion deficiency type I. [more...]