Recurrent Rhodococcus gordoniae eyelid infection after combined septoplasty and blepharoplasty.

Rhodococcus species are rare human pathogens. Most cases of human infection have involved Rhodococcus equi, a natural zoonotic pathogen causing pneumonia in young foals. The human population at risk mainly includes immunocompromised patients. Infection of immunocompetent hosts has been rare, with less than 30 reported cases in the literature. The authors report a first case of recurrent Rhodococcus gordoniae granulomatous lower eyelid infection that occurred after an immunocompetent 44-year-old woman underwent a combined intranasal and lower blepharoplasty procedure. A literature search revealed only 10 reported cases of non-R. equi rhodococcal infections, most involving traumatic inoculation; 5 of these cases involved the eye and ocular adnexa. To the author's knowledge, this is the first case report of a non-R. equi rhodococcal infection of the eyelids. Identification of Rhodococcus by most laboratories is difficult, and in this case, 2 of 3 cultures were misidentified prior to definitive testing at a specialized laboratory. Multidrug resistance is also a concern, and the treatment course could be long and difficult.