[Bilateral periocular necrotizing fasciitis with unilateral orbital involvement]

Area of Science:

• Infectious Diseases
• Mycology
• Ophthalmology

Background:

• Necrotizing fasciitis is a severe soft tissue infection.
• Orbital involvement complicates head and neck infections.
• Mixed microbial infections present diagnostic and therapeutic challenges.

Observation:

• An 82-year-old female presented with bilateral necrotizing fasciitis and unilateral orbital cellulitis.
• Microbiological analysis revealed a polymicrobial infection involving Streptococcus pyogenes, Staphylococcus aureus, and Aspergillus fumigatus.
• Aspergillus fumigatus was identified using advanced molecular pathological techniques.

Findings:

• The patient underwent surgical debridement and received broad-spectrum antibiotics and antifungals.
• Low-dose systemic corticosteroids were administered during the acute inflammatory phase.
• Successful management led to the remission of acute inflammation and uneventful healing by secondary intention.

Implications:

• This case highlights the importance of identifying fungal co-infections in severe bacterial infections.
• Molecular pathology aids in the rapid and accurate diagnosis of rare pathogens.
• Multimodal treatment strategies are crucial for managing complex necrotizing infections with orbital extension.