Life-threatening periocular pseudomonal necrotizing fasciitis in an immunocompetent infant

Necrotizing fasciitis, a severe soft tissue bacterial infection, is uncommon in the periocular region due to its rich blood supply. This report highlights a rare case in an immunocompetent infant.

A 10-month-old immunocompetent female exhibited fever, irritability, and right eyelid swelling post-fall. Despite initial treatment with cephalexin for presumed cellulitis, her condition rapidly deteriorated, suggesting necrotizing fasciitis. She stabilized after receiving broad-spectrum intravenous antibiotics and aggressive surgical debridement but later required orbital exenteration due to extensive tissue necrosis.

Periocular necrotizing fasciitis is exceedingly rare, particularly in immunocompetent individuals. Prompt diagnosis and treatment are critical to mitigate morbidity and mortality.