Conservative management of periorbital necrotizing fasciitis caused by methicillin-resistance Staphylococcus aureus

A case of successful treatment of Fournier's gangrene through conservative management and elective debridement

Introduction

Fournier's gangrene refers to a necrotizing fasciitis that mainly affects the perineal region and a condition that requires immediate debridement. This case involved elective debridement of Fournier's gangrene after the general condition was improved through antibiotic treatment instead of requesting an emergency debridement.

Case presentation

The patient was an 85-year-old man with a performance status of 4 admitted to a nursing home. He was transferred by ambulance with a fever. Blood tests showed a markedly elevated inflammatory response, and computed tomography revealed widespread aerodermectasia around the right testis to the lower abdomen. The patient was diagnosed with Fournier's gangrene. However, his family declined emergency surgical debridement. The patient's general condition was improved with antibiotics, and debridement was eventually performed. After 52 days of hospitalization, the patient was transferred to another hospital.

Conclusion

This study describes the successful treatment of Fournier's gangrene through conservative treatment followed by elective debridement.

Pathophysiological Considerations in Periorbital Necrotizing Fasciitis: A Case Report

BACKGROUND

Periorbital necrotizing fasciitis (PNF) is a rare complication of bacterial infection, associated with irreversible inflammatory destruction of soft tissues like subcutaneous tissue and superficial fascia. PNF can cause visual loss, septic shock and death within hours to days. Since the infection progresses rapidly from a local disease to septic shock, prompt identification and decisive interventions are mandatory.

AIM

Considering pathophysiology, differential diagnosis, and treatment options, we report a case of PNF and its outcome.

METHODS

A 69 years old male with febrile periorbital swelling had been diagnosed with bilateral PNF, caused by dual infection with Streptococcus pyogenes (S. pyogenes) and Staphylococcus aureus (S. aureus) based on conjunctival swabs.

RESULTS

The superantigens produced by S. pyogenes have been identified as key to the rapid dissemination of infection and severity of systemic manifestations.

CONCLUSION

A combination of intravenous antibiotics and regular surgical debridements resulted in a beneficial outcome in our patient.