We report the case of a 56-year-old man, previously well, who presented with a spontaneous right-sided periorbital necrotising soft tissue infection and subsequently found to have undiagnosed hepatitis C and liver cirrhosis. The patient presented with rapid onset right eye pain, periorbital swelling and septic shock. CT scan revealed diffuse inflammatory changes to the soft tissue anterior to the right eye. The initial treatment included intravenous antibiotics, emergency debridement of necrotic tissue and admission to intensive care. Group A streptococcus was cultured from the debrided tissue. The patient developed decompensated liver failure and life-threatening haematemesis. Liver screening detected hepatitis C positive serology, the only risk factor for which was an old tattoo. The patient was effectively managed by early involvement of multiple clinical teams. We review the literature surrounding periorbital necrotising fasciitis, discuss the evidence for hepatic disorders as a potential cause and make recommendations for managing these patients.
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Contributors The article was written by the two first authors NC-M and HL. This involved detailed examination of the patient records and literature review using online medical databases accessed via our institution. NC-M and HL jointly planned the paper, gained necessary permissions and acquired the relevant data from patient notes for the case report. NC-M performed the first literature review and HL performed additional literature review and these were combined to produce the body of evidence from the literature that supports our case report. NC-M developed early drafts of the publication and HL redrafted these. The two first authors are joint first authors in this work. SA-H, the senior and second author, reviewed and added to the manuscript. This applied a more detailed clinical knowledge and familiarity with the case, as well as further literature review. CS, the primary carer for the patient, edited the manuscript for accuracy, gave final approval for publication and provided the clinical images for the manuscript. All authors agree on the final version of the article to be published.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Obtained.
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