Group A Streptococcus Necrotizing Fasciitis of the Eyelid

Abstract

Periorbital necrotizing fasciitis is a potentially fatal disease, and early surgical debridement has been advocated to minimize the risk of blindness and mortality. The authors report a case of an 18-year-old man who presented with isolated, unilateral group A Streptococcus eyelid necrotizing fasciitis. The patient responded to intravenous antibiotics alone, and no surgical debridement was needed. Skin reconstructive surgery was carried out after resolution of the acute infection. The clinical and cosmetic outcome was good. This case report supports limited but growing evidence that potentially disfiguring surgical debridement may be avoided in selected cases of eyelid necrotizing fasciitis and that uncomplicated periorbital necrotizing fasciitis can be treated conservatively with good results.

A 64-Year-Old Man With Swollen, Blistered Eyelids

“…[2][3][4] Occasional cases of PNF have been treated successfully with antibiotics alone. 6,7 Medical treatment, in theory, preserves tissue to minimize postinfectious disfigurement and morbidity; however, the main goal in acute PNF treatment is eradication of infection to prevent mortality, which usually requires debridement. [2][3][4]6,7 The decision to treat with medical treatment alone requires extremely close monitoring, with the surgeon ready to take the patient to the operating room at any time should there be worsening of the clinical condition.…”

“…6,7 Medical treatment, in theory, preserves tissue to minimize postinfectious disfigurement and morbidity; however, the main goal in acute PNF treatment is eradication of infection to prevent mortality, which usually requires debridement. [2][3][4]6,7 The decision to treat with medical treatment alone requires extremely close monitoring, with the surgeon ready to take the patient to the operating room at any time should there be worsening of the clinical condition. Mortality from periorbital PNF is 6% to 14%, lower than in other parts of the body (20%-30%) but not insignificant, and is associated with delayed presentation and infection with group A β-hemolytic Streptococcus.…”

“…Occasional cases of PNF have been treated successfully with antibiotics alone . Medical treatment, in theory, preserves tissue to minimize postinfectious disfigurement and morbidity; however, the main goal in acute PNF treatment is eradication of infection to prevent mortality, which usually requires debridement .…”

Unilateral Periorbital Necrotizing Fasciitis – A Case Report

“…Necrotizing fasciitis (NF) is the most common necrotizing soft tissue infection (NSTI) [1]. NF is a bacterial infection with a high mortality rate; that leads to the rapid destruction of the muscle fascia and subcutaneous adipose tissue [1][2][3][4][5][6][7][8][9][10]. The incidence of NF is estimated at 0.3 to 15 cases per 100.000.000 population [1].…”

“…NF in the head and neck region and especially the face is extremely rare [3]. The mortality rate for upper facial infections is as high as 12.5% of cases [4].…”