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Pertea M, Fotea MC, Luca S, Moraru DC, Filip A, Olinici-Temelie D, Lunca S, Carp AC, Grosu OM, Amarandei A, Veliceasa B. Periorbital Facial Necrotizing Fasciitis in Adults: A Rare Severe Disease with Complex Diagnosis and Surgical Treatment-A New Case Report and Systematic Review. J Pers Med 2023; 13:1612. [PMID: 38003927 PMCID: PMC10672041 DOI: 10.3390/jpm13111612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Necrotizing fasciitis (NF) is a severe and aggressive pathology with a rapid progression and high mortality risk. Periocular NF is a rare condition associated with a lower mortality risk but significantly higher disabling sequelae. (2) Methods: We present the case of a 67-year-old homeless patient, a victim of assault, with multiple untreated comorbidities (diabetes mellitus, cardiac conditions, and schizophrenia) and a delayed diagnosis of periocular necrotizing fasciitis. The condition showed a cyclical evolution influenced by the existing comorbidities, and the patient underwent both surgical and medical treatment with a multidisciplinary team. Additionally, we report a systematic review of cases from the literature. (3) Results: The patient's survival outcomes were favorable; however, the sequelae were disabling, not only concerning aesthetic aspects but also due to the loss of the affected eye globe. The systematic review revealed the rarity of such cases and the peculiarities of the presented case compared to those reported in the literature up to this point. (4) Conclusions: Understanding the signs, symptoms, and predisposing factors, as well as the potential rare localizations of NF, including the periocular region, can lead to the early diagnosis and treatment with good functional and aesthetic outcomes, minimizing significant disabilities.
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Affiliation(s)
- Mihaela Pertea
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Madalina-Cristina Fotea
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Stefana Luca
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Dan Cristian Moraru
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Alexandru Filip
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Doinita Olinici-Temelie
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Dermatology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Sorinel Lunca
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Second Surgery Clinic, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Adrian Claudiu Carp
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Oxana-Madalina Grosu
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Alexandru Amarandei
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Bogdan Veliceasa
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
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Hadizamani Y, Anastasi S, Schori A, Lucas R, Garweg JG, Hamacher J. Pathophysiological Considerations in Periorbital Necrotizing Fasciitis: A Case Report. Ocul Immunol Inflamm 2023; 31:468-473. [PMID: 35404751 DOI: 10.1080/09273948.2022.2032190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Yalda Hadizamani
- Lungen-und Atmungsstiftung Bern, Bern, Switzerland.,Pneumology, Clinic for General Internal Medicine, Lindenhofspital Bern, Bern, Switzerland
| | | | - Anouk Schori
- Lungen-und Atmungsstiftung Bern, Bern, Switzerland.,Pneumology, Clinic for General Internal Medicine, Lindenhofspital Bern, Bern, Switzerland
| | - Rudolf Lucas
- Vascular Biology Center, Medical College of Georgia, University of Augusta, Augusta, Georgia, USA
| | - Justus G Garweg
- Berner Augenklinik Am Lindenhofspital, Bern, Switzerland.,Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland
| | - Jürg Hamacher
- Lungen-und Atmungsstiftung Bern, Bern, Switzerland.,Pneumology, Clinic for General Internal Medicine, Lindenhofspital Bern, Bern, Switzerland.,Medical Clinic V-Pneumology, Allergology, Intensive Care Medicine and Environmental Medicine, Faculty of Medicine, Saarland University, University Medical Centre of the Saarland, Homburg, Germany.,Institute for Clinical & Experimental Surgery, Faculty of Medicine, Saarland University, Homburg, Germany
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