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Blanchard CC, Gupta L, Timoney PJ. Secondary Intention Healing After Debridement for Bilateral Periorbital Necrotizing Fasciitis. Ophthalmic Plast Reconstr Surg 2024; 40:e164-e166. [PMID: 38624148 DOI: 10.1097/iop.0000000000002673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
A 75-year-old male with a history of poorly controlled diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, and obesity presented with severe bilateral periorbital edema with necrosis and purulent discharge. Although hemodynamically stable, laboratory markers indicated systemic toxicity. Imaging showed bilateral periorbital edema extending into the frontal scalp, temporal fossa, and right orbit. Suspected to have necrotizing fasciitis, the patient underwent urgent debridement of bilateral upper and lower eyelids and was found to have postseptal extension of necrosis into the right orbit. During his hospitalization, he was treated with broad-spectrum antimicrobials and underwent a second surgery for exploration and debridement. The patient was lost to follow-up and found to have healed by secondary intention without any surgical reconstruction. Our case demonstrates not only a rare case of necrotizing fasciitis involving all 4 eyelids, but also an exceptional cosmetic and functional result after secondary intention healing.
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Affiliation(s)
- Cody C Blanchard
- Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A
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Atallah NJ, Scherer AK, Alexander NJ, Dagher Z, Viens AL, Muhammed M, Branda JA, Mansour MK. Candida albicans necrotizing fasciitis following elective surgery. Med Mycol Case Rep 2020; 28:39-41. [PMID: 32420013 PMCID: PMC7214761 DOI: 10.1016/j.mmcr.2020.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 11/18/2022] Open
Abstract
Necrotizing fasciitis is a potentially fatal soft tissue infection that requires prompt clinical suspicion, pharmacological and surgical interventions. Bacterial pathogens, such as beta-hemolytic streptococcus and Staphylococcus aureus, are the main etiology of necrotizing fasciitis, however, rare cases caused by fungal pathogens, such as Candida albicans, have been reported following trauma. Here, we present the first case of C. albicans necrotizing fasciitis following an elective surgical procedure in an immunocompetent adult.
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Affiliation(s)
- Natalie J. Atallah
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Allison K. Scherer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Natalie J. Alexander
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Zeina Dagher
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Adam L. Viens
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Maged Muhammed
- Division of Infectious Diseases, Division of Gastroenterology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Adult Inpatient Medicine, Newton Wellesley Hospital, Newton, MA, USA
| | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michael K. Mansour
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Corresponding author. Transplant Infectious Diseases and Immunocompromised Host Service Jackson, 1328A Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
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Amarasekera S, Durrani AF, Faith S, Kowalski RP, Jhanji V. Clinical features of Streptococcus pyogenes keratitis: Case series. Cont Lens Anterior Eye 2019; 42:581-585. [DOI: 10.1016/j.clae.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 11/28/2022]
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Kiat HJ, En Natalie YH, Fatimah L. Necrotizing Fasciitis: How Reliable are the Cutaneous Signs? J Emerg Trauma Shock 2017; 10:205-210. [PMID: 29097860 PMCID: PMC5663140 DOI: 10.4103/jets.jets_42_17] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Necrotizing fasciitis (NF) is a surgical emergency. It is often aggressive and characterized by the rapidly progressive inflammatory infection of the fascia that causes extensive necrosis of the subcutaneous tissue and fascia, relatively sparing the muscle and skin tissue. As the disease progresses, thrombosis of the affected cutaneous perforators subsequently devascularizes the overlying skin. The course indeed can be a fulminant one. The diagnosis of NF, especially in the early stages, is extremely challenging, and it can be very close in presentation to other skin and subcutaneous tissue infections. The primary site of the pathology is the deep fascia. Necrosis of the tissues and fascia may manifest as erythema without sharp margins, swelling, warmth, shiny, and exquisitely tender areas. Pain out of proportion to physical examination findings may be observed. The subcutaneous tissue may be firm and indurated such that the underlying muscle groups cannot be distinctly palpated. Eventually, as the overlying skin is stripped of its blood supply, skin necrosis ensues and hemorrhagic bullae form. Bacteremia and sepsis invariably develop when the infection is well established. This paper discusses some of issues related to the cutaneous signs found in NF and also provides a review the current, available literature on the subject matter.
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Affiliation(s)
- Ho Jun Kiat
- Yong Loo Lin Medical School, National University of, Singapore
| | | | - Lateef Fatimah
- Yong Loo Lin Medical School, National University of, Singapore.,Senior Consultant, Department of Emergency Medicine, Singapore General Hospital, Associate Professor, Duke NUS Graduate Medical School, Singapore
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