Periorbital necrotizing fasciitis post herpes simplex virus infection: A rare case report

Periorbital necrotizing fasciitis (NF) is a rare, rapidly progressing condition with significant systemic impact. We report the case of a 44-year-old healthy woman who developed acute left upper eyelid swelling, initially presented with a left ear infection that was treated with topical measures elsewhere. The condition recurred and extended to the eye, exacerbated by a recent childbirth and increased stress from a demanding job. Imaging revealed periorbital edema without intraocular or intracranial spread. Despite initial empirical treatment, the swelling extended to the contralateral eye within 48 h, accompanied by skin sloughing and necrotic margins, necessitating urgent surgical debridement. Cultures identified Streptococcus pyogenes and herpes simplex virus 1 (HSV-1), and histopathology confirmed extensive necrosis and inflammation. Treatment was adjusted based on culture and sensitivity results, leading to significant improvement. Vision remained unaffected, although cicatricial ectropion and lagophthalmos were expected and managed with subcutaneous mixture of triamcinolone and 5-fluorouracil injections, with future plans for skin grafting. This case highlights the unusual presentation of periorbital NF induced by HSV infection in a healthy young woman. The paper emphasizes the need for early recognition, immediate surgical intervention, and meticulous investigation to reduce progression and minimize morbidity in this rare and clinically challenging condition.