Necrotizing Fasciitis of Eyelid in Children: A Rare Complication of Varicella Infection

Necrotizing fasciitis (NF) of the eyelid is an extremely rare but severe complication of varicella zoster virus (VZV) infection in children. We present a case of an 8-year-old girl who developed necrotizing fasciitis of the left eyelid following varicella infection. The patient initially presented with fever, vesicular rashes, and swelling of the left peri-orbital region. She was treated with oral acyclovir (400 mg five times daily for 7 days) and prednisolone (10 mg daily for 5 days) at a local medical store. Due to worsening symptoms, she was admitted to our center where intravenous antibiotics-Meropenem (40 mg/kg/dose every 8 h) and Vancomycin (15 mg/kg/dose every 6 h)-were administered for 21 days, followed by oral levofloxacin (250 mg once daily for 2 weeks). Surgical debridement of necrotic tissue was performed. Cultures revealed Coagulase-negative Staphylococcus, Enterococcus, and later Acinetobacter baumannii. The patient responded well to treatment and showed healthy healing in follow-up. This case emphasizes the importance of early surgical intervention, aggressive antibiotic therapy, and multidisciplinary care in managing rare but severe complications like periorbital necrotizing fasciitis secondary to varicella. Key clinical findings included progressive periorbital necrosis, culture results, and favorable response to combined medical and surgical therapy.