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Case report
Bilateral periorbital necrotising fasciitis associated with invasive group: a Streptococcus infection
  1. Grace Anne McCabe1,
  2. Thomas Hardy1,2 and
  3. Thomas Gordon Campbell1,3
  1. 1Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  2. 2Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
  3. 3Department of Surgery, University of Melbourne and Centre for Eye Research Australia, East Melbourne, Victoria, Australia
  1. Correspondence to Dr Thomas Gordon Campbell; thomasgordoncampbell{at}gmail.com

Abstract

A previously independent 56-year-old immunocompetent woman presented with septic shock in the setting of periorbital swelling and diffuse infiltrates on chest imaging. Blood cultures were positive for growth of group A Streptococcus (GAS). Broad spectrum antimicrobials were initiated with the inclusion of the antitoxin agent clindamycin. Necrosis of periorbital tissue was noted and surgical consultation was obtained. Débridement of both eyelids with skin grafting was performed. GAS was isolated from wound cultures and also observed on periorbital tissue microscopy. The final diagnosis was bilateral periorbital necrotising fasciitis (PONF) associated with invasive GAS infection. The patient had a prolonged intensive care unit course with input from multiple specialist teams. This case demonstrates the importance of early recognition and treatment of PONF, the profound systemic morbidity caused by these infections, and illustrates successful multidisciplinary teamwork.

  • plastic and reconstructive surgery
  • infectious diseases
  • ophthalmology

http://dx.doi.org/10.1136/bcr-2020-236800

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    Footnotes

    • Contributors GAM, TH and TGC were all involved in care of this patient. GAM drafted the article, gained patient consent and acquired data. TH revised the article critically for important intellectual content and approved final version. TGC was involved in conception and design, revised manuscript critically for important intellectual content and approved final version. All authors are agreeable to be accountable for this article and approved the final version.

    • Funding This study is funded by Hector MacLean CERA2020-2021 fellowship. No award number

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.