A Case of Facial Erysipelas with Necrosis of the Upper Eyelid

Abstract

Erysipelas is a superficial cutaneous process that is usually restricted to the dermis, but with prominent lymphatic involvement commonly caused by streptococci. Here, we report an unusual case of primary gangrenous-phlegmonous erysipelas of the face with necrosis of the upper eyelid. Diagnosing facial erysipelas in this case was particularly challenging due to the atypical clinical and laboratory features, possibly caused by secondary immunodeficiency. A unique aspect of this case is that the disease started without the typical early symptoms, such as a prodrome. The patient did not initially show signs of general intoxication but instead presented with a local skin lesion before developing a fever. The characteristic redness and distinct borders commonly associated with erysipelas were also absent. This case demonstrates primary erysipelas of the face in a gangrenous-phlegmonous form, resulting in the development of upper eyelid necrosis. Key clinical message: Recognizing atypical cases, such as the one presented, is of utmost importance. It is crucial for quick and adequate surgical and therapeutic intervention. This knowledge equips medical professionals with the necessary skills to handle similar situations in the future. The presented clinical case testifies the effectiveness of using A-PRF-membrane to prevent scar formation during wound healing.