Giant Cyst of Dermis-Fat Graft in a Child with MRSA-Case Report

Abstract

Background/objectives: This case report presents a unique case of multiple postoperative complications, including sterile silicone implant extrusion, symblepharon formation, and the development of a giant cyst, following extensive multimodal chemotherapy for unilateral retinoblastoma in a pediatric patient. The case was further complicated by recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization, which persisted despite multiple eradication attempts.

Methods: A 5-year-old boy presented with right-sided proptosis one year after receiving a secondary dermis-fat orbital graft. He had undergone 12 cycles of intravitreal, intra-arterial, and systemic chemotherapy as well as thermotherapy and cryotherapy due to recurrent retinoblastoma in the right eye. Following a third relapse, secondary enucleation was performed with a primary silicone orbital implant. However, extrusion of the implant occurred, and an orbital swab confirmed MRSA colonization. A secondary dermis-fat graft was harvested and implanted after ensuring MRSA clearance. A year later, the child developed rapid right-sided proptosis. Ultrasound revealed a cyst within the dermis-fat graft measured 23.6 mm in anteroposterior diameter. Surgery was postponed due to chickenpox, and the cyst enlarged reaching an anteroposterior diameter of 26.7 mm over two months. A complete excision was performed.

Results: The surgery was uneventful. Intraoperative orbital swab was sterile, but MRSA was detected in a conjunctival swab, leading to treatment with local moxifloxacin drops and oral rifampicin.

Conclusions: Giant cyst formation in a dermis-fat graft is an extremely rare complication. Complete excision remains the treatment of choice. However, in this case, it resulted in persistent anophthalmic socket syndrome, posing further reconstructive challenges.

Keywords: cysts; exophthalmos; methicillin-resistant Staphylococcus aureus; retinoblastoma.

Figure 1

Dermis-fat graft was harvested from the right buttock, precisely midway between the ischial tuberosity and the ipsilateral greater trochanter.

Figure 2

Photograph showing incomplete eyelid closure with upper eyelid retraction (A). Ultrasound B scan revealed cyst with anteroposterior diameter of 26.7 mm containing low-reflective fluid interspersed with fine, dot-like echoes (B).

Figure 3

En bloc excision of the giant cyst.

Figure 4

Photograph showing excised multilobulated fluid-filled giant cyst.