Streptococcal preseptal cellulitis complicated by the toxic Streptococcus syndrome

After decades of decline in the incidence of severe infections secondary to group A streptococci, a dramatic increase in the frequency and severity of infections with these organisms has been reported since 1984, including a "toxic Streptococcus syndrome," resembling staphylococcal toxic shock syndrome. To the authors' knowledge, this entity has never been described after ocular infection.

In a previously healthy 3-year-old boy, preseptal cellulitis developed secondary to minor trauma to the eyelid, progressing rapidly to hypotension, respiratory distress, and an erythrodermic desquamating rash. Ocular and blood cultures grew group A beta-hemolytic streptococci. Appropriate antibiotic coverage and management of systemic manifestations led to rapid improvement, although necrosis developed in the right upper anterior eyelid, requiring skin grafts.

More than 3 years since the incident, the patient is free of infection and has a good cosmetic result after skin grafting and revisions for scarring and adhesions.

Streptococcal preseptal cellulitis is not unusual, particularly after trauma. Ophthalmologists must be aware of the re-emergence of more virulent organisms with increased potential for morbidity and mortality.