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Periorbital necrotising fasciitis secondary to scratching

I A Placinta1, E España-Gregori1, A Rodrigo-Hernández1

  • 1Servicio de Oftalmología, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, España.

Archivos De La Sociedad Espanola De Oftalmologia
|February 9, 2019
PubMed

Insights

A severe eyelid infection (necrotizing fasciitis) after an insect bite rapidly progressed but was treated with antibiotics and surgery. The patient recovered with reconstructive surgery, achieving good functional and cosmetic outcomes.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Plastic Surgery

Background:

  • Necrotizing fasciitis is a severe bacterial infection that can rapidly destroy soft tissue.
  • Periorbital involvement, while rare, poses significant risks to vision and facial structures.

Observation:

  • An 80-year-old woman presented with rapidly progressing eyelid necrosis following an insect bite.
  • Cultures identified Streptococcus pyogenes and Staphylococcus aureus as causative agents.
  • The patient developed streptococcal toxic shock syndrome concurrently.

Findings:

  • Successful treatment involved intravenous antibiotics (ceftriaxone, linezolid) and surgical debridement.
  • Daily wound care included debridement, chlorhexidine disinfection, and topical antimicrobials.
  • Reconstructive surgery using a skin graft and advancement flap restored eyelid function and appearance.

Implications:

  • Prompt diagnosis and aggressive multimodal treatment are crucial for managing periorbital necrotizing fasciitis.
  • Early surgical intervention and reconstruction can lead to favorable cosmetic and functional results.
  • This case highlights the importance of considering severe bacterial infections following seemingly minor trauma.
Keywords:
Fascitis necrosante periorbitariaInsect biteLinezolidPeriorbital necrotising fasciitisPicadura de insectoRascadoScratchingStreptococcal toxic shock syndromeStreptococcus pyogenesSíndrome de shock tóxico estreptocócico

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