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Hojjatie SL, Radulovich N, Van Brummen A, Chambers C, Fu R, Mittenzwei R, Zhang MM. A case of necrotizing fasciitis of the orbit secondary to Aspergillus fumigatus and mixed flora. Orbit 2024:1-4. [PMID: 38796787 DOI: 10.1080/01676830.2024.2353235] [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: 03/13/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
A 79-year-old female presented to the emergency department for sudden-onset ocular pain, edema, and erythema around her left eye. She also had a left-sided migraine and frontal fullness for 2 weeks. She had attentive care for the diagnosis of orbital cellulitis and prompt recognition of necrotizing fasciitis. Wound cultures were positive for over 5 strains of bacteria in addition to Aspergillus. In a combined effort by our institution's Ophthalmology and Otolaryngology departments, the patient was successfully treated with debridement, porcine bladder matrix, antibiotics, and antifungals. The authors describe the first reported case of eyelid and periorbital necrotizing fasciitis, caused by mixed flora and Aspergillus fumigatus, that showed promising wound healing with the outlined treatment paradigm.
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Affiliation(s)
- Sara L Hojjatie
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Nicholas Radulovich
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Alexa Van Brummen
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | | | - Roxana Fu
- Department of Ophthalmology, University of Pittsburg, Pittsburg, Pennsylvania, USA
| | - Rhonda Mittenzwei
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Matthew M Zhang
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
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2
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Arun K, Shah P, Grillon F, Subak-Sharpe I. Periorbital Necrotizing Fasciitis: Presentation to Reconstruction. Cureus 2024; 16:e59501. [PMID: 38826916 PMCID: PMC11144053 DOI: 10.7759/cureus.59501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
Periorbital necrotizing fasciitis (NF) is a devastating bacterial infection associated with irreversible inflammatory destruction of soft tissues. Outcomes include disfigurement, vision loss, septic shock, and death within hours to days. We describe two cases of periorbital NF that presented to our unit within a three-month period. We aim to highlight the key clinical features of periorbital NF, demonstrate the rapid progression of the disease, and the need for prompt identification and decisive intervention. Both patients presented with fever and left-sided periorbital swelling and showed rapid progression of swelling and gangrenous changes to the periorbital skin with worsening proptosis. They were treated with broad-spectrum intravenous antibiotics and underwent emergency surgical debridement of necrotic tissue followed by reconstruction. We propose a formal protocol that we recommend to aid the diagnosis and management of periorbital NF in an acute setting.
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Affiliation(s)
| | - Prachi Shah
- Ophthalmology, Whipps Cross Hospital, London, GBR
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3
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Blanchard CC, Gupta L, Timoney PJ. Secondary Intention Healing After Debridement for Bilateral Periorbital Necrotizing Fasciitis. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00375. [PMID: 38624148 DOI: 10.1097/iop.0000000000002673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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4
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Schuh A, Keidel L, Siegmund B, Otto S, Priglinger S, Hintschich C. Locally Increased Incidence of Periorbital Necrotizing Fasciitis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:595-596. [PMID: 37767577 PMCID: PMC10552625 DOI: 10.3238/arztebl.m2023.0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Anna Schuh
- Ludwig-Maximilians-Universität München, Klinik und Poliklinik für Augenheilkunde, München
| | - Leonie Keidel
- Ludwig-Maximilians-Universität München, Klinik und Poliklinik für Augenheilkunde, München
| | - Birte Siegmund
- Ludwig-Maximilians-Universität München, Klinik und Poliklinik für Mund-Kiefer-Gesichtschirurgie, München
| | - Sven Otto
- Ludwig-Maximilians-Universität München, Klinik und Poliklinik für Mund-Kiefer-Gesichtschirurgie, München
| | - Siegfried Priglinger
- Ludwig-Maximilians-Universität München, Klinik und Poliklinik für Augenheilkunde, München
| | - Christoph Hintschich
- Ludwig-Maximilians-Universität München, Klinik und Poliklinik für Augenheilkunde, München
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5
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Gupta V, Pal H, Das S, Pathuri DS, Vathulya M. Varicella Zoster Reactivation Manifesting as Serpiginous Peripheral Keratitis and Disciform Keratitis Occurring After Necrotizing Fasciitis in an Immunocompromised Male: A Case Report. Cureus 2023; 15:e40787. [PMID: 37485163 PMCID: PMC10362786 DOI: 10.7759/cureus.40787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Reactivation of herpes zoster ophthalmicus (HZO) can present as corneal involvement without any precedent neuralgia or characteristic herpetic rash. This form of HZO can be the first manifestation of reactivation of varicella zoster virus and can masquerade as peripheral ulcerative keratitis. A 45-year-old male treated for necrotizing fasciitis (NF) one month back presented with painful diminution of vision in the right eye (RE) for two weeks without any associated vesicular rash or neuralgia. On examination, best-corrected visual acuity in RE was 2/60 with non-marginal upper lid defect, and multiple linear contracture scars involving the upper lid, right temple, and preauricular region. There were associated peripheral corneal ring infiltrates, disc-shaped central stromal edema, and reduced corneal sensation. The patient had a history of chicken pox in childhood and was recently diagnosed with seropositive rheumatoid arthritis (RA). Though corneal scrapings were negative on Tzanck smear, a presumptive clinical diagnosis of herpetic disciform keratitis was made, and the patient was started on oral and topical acyclovir with steroids. This was confirmed with improving clinical course and detection of herpes zoster DNA on polymerase chain reaction from corneal scrapings. Lid reconstruction for associated lid defect was performed using paramedian forehead flap, which was remodeled at 16 weeks. Our case, a seropositive RA patient, had reactivation of varicella zoster manifesting as peripheral serpiginous and disciform keratitis activated after NF. There are a few case reports of periorbital NF following HZO in immunocompromised patients. However, till date, no case of HZO occurring after periorbital NF has been reported. Also, in our case, reactivation of HZO presented as disciform and serpiginous keratitis without any precedent herpetic rash or neuralgia.
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Affiliation(s)
- Vinita Gupta
- Ophthalmology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Himani Pal
- Ophthalmology, Government Doon Medical College, Dehradun, IND
| | - Sucharita Das
- Ophthalmology, Oculoplasty, Orbit & Ocular Oncology, Institute of Medical Sciences and Sum Hospital, Bhubaneswar, IND
| | | | - Madhubari Vathulya
- Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, Rishikesh, IND
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Passemard L, Hida S, Barrat A, Sakka L, Barthélémy I, Dang NP. Eyelid and periorbital necrotizing fasciitis, a severe preseptal infection, a systemic review of the literature and anatomical illustrations. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023:101498. [PMID: 37178871 DOI: 10.1016/j.jormas.2023.101498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
In necrotizing fasciitis, aggressive surgical debridement and broad-spectrum antibiotics are the cornerstone of treatment but cannot be proposed for the eyelid and periorbital area because of the risk of blindness, eyeball exposure and disfiguration. The aim of this review was to determine the most effective management of this severe infection while preserving eye function. A literature search of the PubMed, Cochrane Library, ScienceDirect and Embase databases was conducted for all articles published up to March 2022; 53 patients were included. Management was probabilistic, combining antibiotic therapy with skin (+/- orbicularis oculi muscle) debridement in 67.9 % of cases, and probabilistic antibiotic therapy alone in 16.9% of cases. Radical surgery with exenteration was performed in 11.1% of patients; 20.9% of patients had complete loss of vision, and 9.4% died of the disease. Aggressive debridement was rarely necessary possibly because of the anatomical particularities of this region.
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Affiliation(s)
- Léa Passemard
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France..
| | - Sarah Hida
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France..
| | - Antoine Barrat
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France..
| | - Laurent Sakka
- Laboratoire d'anatomie, Faculté de Médecine, Université d'Auvergne, 28, place Henri-Dunant, 63001 Clermont-Ferrand cedex 1, France..
| | - Isabelle Barthélémy
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France.; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Université d'Auvergne, Clermont-Ferrand, 63003, France..
| | - Nathalie Pham Dang
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, F-63000, Clermont-Ferrand, France.; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Université d'Auvergne, Clermont-Ferrand, 63003, France..
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7
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Nyirjesy SC, Judd RT, Alfayez Y, Lancione P, Swendseid B, von Windheim N, Nogan S, Seim NB, VanKoevering KK. Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report. 3D Print Med 2023; 9:4. [PMID: 36813875 PMCID: PMC9948423 DOI: 10.1186/s41205-022-00166-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/31/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Complex facial wounds can be difficult to stabilize due to proximity of vital structures. We present a case in which a patient-specific wound splint was manufactured using computer assisted design and three-dimensional printing at the point-of-care to allow for wound stabilization in the setting of hemifacial necrotizing fasciitis. We also describe the process and implementation of the United States Food and Drug Administration Expanded Access for Medical Devices Emergency Use mechanism. CASE PRESENTATION A 58-year-old female presented with necrotizing fasciitis of the neck and hemiface. After multiple debridements, she remained critically ill with poor vascularity of tissue in the wound bed and no evidence of healthy granulation tissue and concern for additional breakdown towards the right orbit, mediastinum, and pretracheal soft tissues, precluding tracheostomy placement despite prolonged intubation. A negative pressure wound vacuum was considered for improved healing, but proximity to the eye raised concern for vision loss due to traction injury. As a solution, under the Food and Drug Administration's Expanded Access for Medical Devices Emergency Use mechanism, we designed a three-dimensional printed, patient-specific silicone wound splint from a CT scan, allowing the wound vacuum to be secured to the splint rather than the eyelid. After 5 days of splint-assisted vacuum therapy, the wound bed stabilized with no residual purulence and developed healthy granulation tissue, without injury to the eye or lower lid. With continued vacuum therapy, the wound contracted to allow for safe tracheostomy placement, ventilator liberation, oral intake, and hemifacial reconstruction with a myofascial pectoralis muscle flap and a paramedian forehead flap 1 month later. She was eventually decannulated and at six-month follow-up has excellent wound healing and periorbital function. CONCLUSIONS Patient-specific, three-dimensional printing is an innovative solution that can facilitate safe placement of negative pressure wound therapy adjacent to delicate structures. This report also demonstrates feasibility of point-of-care manufacturing of customized devices for optimizing complex wound management in the head and neck, and describes successful use of the United States Food and Drug Administration's Expanded Access for Medical Devices Emergency Use mechanism.
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Affiliation(s)
- Sarah C. Nyirjesy
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Ryan T. Judd
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Yazen Alfayez
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Peter Lancione
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Brian Swendseid
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Natalia von Windheim
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Stephen Nogan
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Nolan B. Seim
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Kyle K. VanKoevering
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
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8
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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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9
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Dolan S, Paterson T, Buchanan MA. Necrotising fasciitis of the head and neck: A case series from the West of Scotland. Clin Otolaryngol 2023; 48:489-494. [PMID: 36637367 DOI: 10.1111/coa.14035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 12/04/2022] [Accepted: 12/31/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Sean Dolan
- Department of Otolaryngology, Glasgow Royal Infirmary, Glasgow, UK
| | - Tom Paterson
- Department of Otolaryngology, Glasgow Royal Infirmary, Glasgow, UK
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10
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Ahmadzada S, Rao A, Ghazavi H. Necrotizing fasciitis of the face: current concepts in cause, diagnosis and management. Curr Opin Otolaryngol Head Neck Surg 2022; 30:270-275. [PMID: 35906981 DOI: 10.1097/moo.0000000000000820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Necrotizing fasciitis of the face is uncommon but potentially life threatening. With adequate multidisciplinary treatment, mortality and has significantly improved. This article highlights current concepts and supporting literature in the management of facial necrotizing fasciitis. RECENT FINDINGS Management of necrotizing fasciitis involving the face requires a multisciplinary team approach, including early medical and surgical intervention. With early haemodynamic support, broad spectrum antibiotics and aggressive surgical debridement, mortality has reduced significantly. Soft-tissue reconstruction can be effectively utilized once the infection has been adequately treated. Although some adjunctive treatment such as vacuum assisted closure dressing has shown to be of benefit, other treatments such as hyperbaric oxygen remains controversial. SUMMARY Necrotizing fasciitis is an aggressive soft tissue involving that rapidly spreads along fascial planes. Necrotizing fasciitis involving the face is rare owing to its rich blood supply but is also difficult to manage due to the complex regional anatomy. Common sources are odontogenic, sinugenic, peritonsillar or salivary gland infections and often polymicrobial. The principles of treatment include early and aggressive haemodynamic support, broad spectrum antibiotics and aggressive surgical debridement. Often times repeat debridements following close monitoring is required. Reconstructive options are viable only after the infection has been adequately treated. Although mortality has significantly improved, mediastinal involvement, multiple comorbidities and delayed treatment confers a worse prognosis.
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Affiliation(s)
- Sejad Ahmadzada
- University of Sydney, Sydney
- Department of Otolaryngology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Amshuman Rao
- University of Sydney, Sydney
- Department of Otolaryngology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Hossein Ghazavi
- Department of Otolaryngology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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Weller JM, Messmer E. Focus on Ophthalmopathology - Orbital Infections from Hordeolum to Necrotizing Fasciitis. Klin Monbl Augenheilkd 2022; 239:886-893. [PMID: 35858598 DOI: 10.1055/a-1709-6152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
(Peri)orbital infections comprise a multitude of diagnoses, ranging from common hordeolum to rare but life-threatening necrotizing fasciitis. However, these disease entities are rarely diagnosed by an ophthalmic pathologist because (peri)orbital infections are usually diagnosed clinically, with the help of imaging and microbiological techniques when indicated. In this review article, the role of ophthalmopathology in the diagnosis of (peri)orbital infections is illustrated on the basis of several exemple diagnoses. An infectious hordeolum must be distinguished from a noninfectious chalazion. A nodular thickening of the eyelid, which is diagnosed and treated as a chalazion, can hide a malignant neoplasia. The correct diagnosis and treatment of canaliculitis is often delayed. In this context the most common causative organism, Actinomyces, can be depicted histologically, as can lacrimal stones/dacryoliths. Necrotizing fasciitis is a rapidly worsening infection of the fascia, which can lead to necrosis, sepsis, and death. During the Sars-CoV2 pandemic, an increased incidence of mucormycosis cases was observed, especially in India. This superinfection was facilitated by the widespread use of steroids and immunosuppression. Histologically, it is possible to visualize infiltration of vessel walls by the fungus. Ophthalmopathology contributes to the diagnosis and to understanding the pathophysiology of these diseases.
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Affiliation(s)
- Julia M Weller
- Augenheilkunde, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Elisabeth Messmer
- Augenklinik, Ludwig-Maximilians-Universität München, Medizinische Fakultät, Deutschland
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12
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Rothschild MI, Pacheco RR, Wladis EJ. Predicting severity of periorbital necrotizing fasciitis. Orbit 2022; 42:228-232. [PMID: 35686501 DOI: 10.1080/01676830.2022.2087231] [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
PURPOSE To determine whether severity of periorbital necrotizing fasciitis can be predicted based on premorbid patient characteristics. METHODS Records of 10 consecutive patients with periorbital necrotizing fasciitis presenting at a single center, treated by one attending ophthalmic plastic surgeon, were retrospectively reviewed. Demographic information and medical history were used to determine a Charlson Comorbidity Index (CCI) score for each patient. Other variables included presenting visual acuity, number of surgical debridements performed, infectious organism (if known), and visual acuity at last follow-up. Data were compared with Mann-Whitney U test to determine correlation between variables, using p-values as outcome measures. RESULTS Increased age at presentation correlated with worse presenting and final visual acuity, requiring more surgical debridements to control disease (each p < .0001). Worse initial visual acuity correlated with need for increased number of debridements (p = .002), but increased number of debridements did not correlate with final visual acuity (p = .101). CCI did not correlate with initial vision (p = .30), final vision (p = .72), or number of surgical debridements necessary (p = .99). Presenting visual acuity did not correlate with final visual acuity (p = .268). CONCLUSION Older patients have more severe cases of periorbital necrotizing fasciitis, as defined by increased number of surgeries required to control disease and worse visual outcomes. CCI did not correlate with severity of disease.
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Affiliation(s)
- Michael I Rothschild
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, Albany, New York, USA
| | | | - Edward J Wladis
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, Albany, New York, USA
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13
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Kakimoto S, Harada Y, Shimizu T. Periorbital Necrotizing Fasciitis. J Gen Intern Med 2022; 37:2086-2087. [PMID: 35304696 PMCID: PMC9198122 DOI: 10.1007/s11606-022-07484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Shintaro Kakimoto
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan.
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14
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Mosenia A, Shahlaee A, Giese I, Winn BJ. Polymicrobial odontogenic periorbital and orbital necrotizing fasciitis (PONF): A case report. Am J Ophthalmol Case Rep 2022; 26:101439. [PMID: 35243174 PMCID: PMC8881414 DOI: 10.1016/j.ajoc.2022.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/30/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To present a case of periorbital and orbital necrotizing fasciitis (PONF) from an odontogenic source with a distinct microbiologic profile and highlight the need for emergent multidisciplinary management. Observations A 39-year-old man presented with periorbital swelling, pain, and erythema following facial trauma. Imaging revealed peri-dental collections, accompanying maxillary sinusitis, and pre- and post-septal involvement. Immediate surgical debridement of necrotic tissue along with broad-spectrum antibiotics were pursued for management. Cultures grew multiple organisms, most notably Streptococcus milleri group and Staphylococcus lugdunensis. Conclusions and Importance PONF is a rare yet potentially fatal disease. Streptococcus milleri group and a fulminant course are to be suspected when the source is odontogenic. Timely multidisciplinary surgical debridement and medical management with intravenous antibiotics is critical for best outcomes. Odontogenic cases of periorbital and orbital necrotizing fasciitis (PONF) may have a fulminant course. Streptococcus milleri group is associated with odontogenic PONF. An emergent multi-disciplinary surgical and medical approach to PONF is highly recommended. Antibiotics may be optimized based on known virulence factors of suspected organisms.
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Affiliation(s)
- Arman Mosenia
- Department of Ophthalmology, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA
- School of Medicine, University of California, San Francisco, 533 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Abtin Shahlaee
- Department of Ophthalmology, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA
| | - Isaiah Giese
- Department of Ophthalmology, California Pacific Medical Center, 711 Van Ness Avenue, San Francisco, CA, 94102, USA
| | - Bryan J. Winn
- Department of Ophthalmology, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA
- San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA, 94121, USA
- Corresponding author. 490 Illinois Street, Floor 5, University of California, San Francisco, CA, 94143, USA.
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15
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Wladis EJ. Periorbital Necrotizing Fasciitis. Surv Ophthalmol 2022; 67:1547-1552. [DOI: 10.1016/j.survophthal.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
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16
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Abstract
ABSTRACT Necrotizing fasciitis of the face and scalp is a severe bacterial infection that can result in long-term morbidity or even mortality if not properly managed. In a third-world country like Ghana, where most of the population relies on daily income for livelihood, citizens with diseases that have long-term morbidity suffer financial difficulty, particularly when the patient is the breadwinner.This brief clinical study demonstrates the severity of necrotizing fasciitis of the face and scalp originated from oral infection, and its capability to affect any part of the body if proper treatment is not established at early onset of disease. Correct diagnosis, patient education, early antibiotic treatment, and timely surgery are crucial for controlling infection and for preventing irreparable damage. Therefore, public education is crucial in preventing such infection by discouraging use of over-the-counter medication in such situations.
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17
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Lee YK, Lai CC. Concurrent Pseudomonas Periorbital Necrotizing Fasciitis and Endophthalmitis: A Case Report and Literature Review. Pathogens 2021; 10:pathogens10070854. [PMID: 34358004 PMCID: PMC8308623 DOI: 10.3390/pathogens10070854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Necrotizing fasciitis (NF) is an infection involving the superficial fascia and subcutaneous tissue. Endophthalmitis is an infection within the ocular ball. Herein we report a rare case of concurrent periorbital NF and endophthalmitis, caused by Pseudomonas aeruginosa (PA). We also conducted a literature review related to periorbital PA skin and soft-tissue infections. (2) Case presentation: A 62-year-old male had left upper eyelid swelling and redness; orbital cellulitis was diagnosed. During eyelid debridement, NF with the involvement of the upper Müller’s muscle and levator muscle was noted. The infection soon progressed to scleral ulcers and endophthalmitis. The eye developed phthisis bulbi, despite treatment with intravitreal antibiotics. (3) Conclusions: Immunocompromised individuals are more likely than immunocompetent hosts to be infected by PA. Although periorbital NF is uncommon due to the rich blood supply in the area, the possibility of PA infection should be considered in concurrent periorbital soft-tissue infection and endophthalmitis.
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Affiliation(s)
- Yu-Kuei Lee
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Chun-Chieh Lai
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Correspondence: ; Tel.: +886-6-235-3535-5441
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18
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Yazıcı B, Sabur H, Toka F. Periocular Necrotizing Fasciitis Causing Posterior Orbitopathy and Vision Loss: How to Manage? Turk J Ophthalmol 2021; 51:181-183. [PMID: 34187154 PMCID: PMC8251672 DOI: 10.4274/tjo.galenos.2021.17364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Necrotizing fasciitis (NF) is a rare, rapidly progressive bacterial infection. Periorbital NF may spread from the eyelid into the posterior orbit. Extent of the infection is critical in planning surgical debridement. A diabetic 70-year-old man presented with a black wound and severe pain in the left periorbital area following a mild trauma. Clinical findings were consistent with NF involving the eyelids, temporal and malar regions. In addition, he had proptosis, diffuse ophthalmoplegia, and central retinal artery occlusion, suggesting deep orbital involvement. Computed tomography showed soft tissue abnormalities in the anterior orbit. The patient was successfully treated with subcutaneous debridement, antibiotherapy, and metabolic support. Periorbital NF may be complicated with posterior orbital cellulitis-like symptoms and retinal vascular occlusions, possibly because of remote vascular thrombi induced by bacterial toxins. This clinical manifestation should be distinguished from true bacterial invasion of the posterior orbit, which may require more aggressive surgical treatments such as exenteration.
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Affiliation(s)
- Bülent Yazıcı
- Uludağ University Faculty of Medicine, Department of Ophthalmology, Bursa, Turkey
| | - Huri Sabur
- Uludağ University Faculty of Medicine, Department of Ophthalmology, Bursa, Turkey
| | - Fatih Toka
- Uludağ University Faculty of Medicine, Department of Ophthalmology, Bursa, Turkey
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19
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Rossetto JD, Forno EA, Morales MC, Moreira JC, Ferrari PV, Herrerias BT, Hirai FE, Gracitelli CPB. Upper Eyelid Necrosis Secondary to Hordeolum: A Case Report. Case Rep Ophthalmol 2021; 12:270-276. [PMID: 34054469 PMCID: PMC8138243 DOI: 10.1159/000513958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/20/2020] [Indexed: 12/02/2022] Open
Abstract
We reported a case of upper eyelid necrosis initially misdiagnosed as a preseptal cellulitis following a hordeolum externum resulting in great damage to the upper eyelid (anterior lamella). The infection was successfully treated with surgical cleansing, drainage, and endovenous antibiotics. Early treatment may avoid severe complications such as eyelid deformity, systemic involvement, and blindness.
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Affiliation(s)
- Júlia D Rossetto
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Department of Pediatric Ophthalmology, Institute of Childcare and Pediatrics Martagão Gesteira-Federal University of Rio de Janeiro (IPPMG-UFRJ), Rio de Janeiro, Brazil
| | | | - Melina Correia Morales
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, São Paulo, Brazil.,Vera Cruz Oftalmologia, Campinas, Brazil.,Fundação Roberto Rocha Brito, Hospital Vera Cruz, Campinas, Brazil
| | - Julio Cesar Moreira
- Vera Cruz Oftalmologia, Campinas, Brazil.,Fundação Roberto Rocha Brito, Hospital Vera Cruz, Campinas, Brazil
| | - Pedro V Ferrari
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, São Paulo, Brazil.,Vera Cruz Oftalmologia, Campinas, Brazil.,Fundação Roberto Rocha Brito, Hospital Vera Cruz, Campinas, Brazil
| | - Bruno T Herrerias
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, São Paulo, Brazil.,Vera Cruz Oftalmologia, Campinas, Brazil.,Fundação Roberto Rocha Brito, Hospital Vera Cruz, Campinas, Brazil
| | - Flavio E Hirai
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, São Paulo, Brazil.,Vera Cruz Oftalmologia, Campinas, Brazil.,Fundação Roberto Rocha Brito, Hospital Vera Cruz, Campinas, Brazil
| | - Carolina P B Gracitelli
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Estudos Alcides Hirai, Ver Mais Oftalmologia, São Paulo, Brazil.,Vera Cruz Oftalmologia, Campinas, Brazil.,Fundação Roberto Rocha Brito, Hospital Vera Cruz, Campinas, Brazil
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20
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Abstract
This article provides an overview of rare orbital diseases. Congenital
malformations, inflammatory diseases, benign and malignant neoplasias are
described. Although it represents a relatively small area of the body the
orbit contains multiple different tissues. Therefore, a great variety of
diseases can be found within the orbital space. That is the reason, why both
the completeness and the level of detail in the description of particular
diseases must be somewhat limited. Nevertheless, clinical manifestations,
important aspects of diagnosis, treatment strategies, and, when specific
data are available, the prognosis are described. The authors tried to
highlight the most characteristic aspects of the different diseases to
describe their relevant aspects in spite of the brevity of the
subsections.
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Affiliation(s)
- Ulrich Kisser
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
| | - Jens Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde, Halle/S. (Klinikdirektor: Prof. Dr. med. A. Viestenz)
| | - Alexander Glien
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
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21
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McCabe GA, Hardy T, Campbell TG. Bilateral periorbital necrotising fasciitis associated with invasive group: a Streptococcus infection. BMJ Case Rep 2020; 13:13/12/e236800. [PMID: 33370943 DOI: 10.1136/bcr-2020-236800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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.
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Affiliation(s)
- Grace Anne McCabe
- Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Thomas Hardy
- Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Thomas Gordon Campbell
- Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia .,Department of Surgery, University of Melbourne and Centre for Eye Research Australia, East Melbourne, Victoria, Australia
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22
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Conservative management of periorbital necrotizing fasciitis caused by methicillin-resistance Staphylococcus aureus. Can J Ophthalmol 2020; 56:e86-e88. [PMID: 33160919 DOI: 10.1016/j.jcjo.2020.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/19/2020] [Accepted: 10/14/2020] [Indexed: 11/21/2022]
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23
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Compton RA, Konstantinou EK, Kapadia MK, Scott AR. Optimizing aesthetics following surgical management of periorbital necrotizing fasciitis. Am J Otolaryngol 2020; 41:102668. [PMID: 32841764 DOI: 10.1016/j.amjoto.2020.102668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
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24
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Necrotizing fasciitis of the periorbital region: from presentation to reconstructive journey. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020; 44:531-536. [PMID: 32952307 PMCID: PMC7490476 DOI: 10.1007/s00238-020-01743-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/09/2020] [Indexed: 11/02/2022]
Abstract
Periorbital necrotizing fasciitis is a very rare condition with a UK incidence of 0.24 cases per million per annum. Outcomes can range from disfigurement to sight loss and even death. Debridement is crucial when sight or life is threatened and the subsequent reconstructive stages can be challenging. We describe two cases of periocular necrotizing fasciitis demonstrating the progression of the disease as well as the surgical debridement for both pre-septal and post-septal disease and the reconstructive steps leading to outcome. Level of evidence: Level V, therapeutic study.
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25
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Abtahi SMB, Eghtedari M, Hosseini S, Shirvani M, Talebi A, Masihpoor N, Mohaghegh S, Hamidianjahromi A, Hosseini M. Non-medial infectious orbital cellulitis: etiology, causative organisms, radiologic findings, management and complications. J Ophthalmic Inflamm Infect 2020; 10:22. [PMID: 32893308 PMCID: PMC7475137 DOI: 10.1186/s12348-020-00213-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Orbital cellulitis is an ophthalmic emergency, which is associated with vision-threatening adverse effects. The purpose of this study is investigating etiology, radiologic findings, management and complications of patients with non-medial orbital cellulitis. METHOD A retrospective medical record and radiologic file review of patients with infectious orbital cellulitis was performed to detect all patients with non-medial orbital cellulitis who referred to Khalili hospital from 2016 to 2019. Age, sex, origin of infection, size of collection or abscess, medical or surgical management, microbiology, first and final best-corrected visual acuity, duration of admission, and complications was recorded. Patients divided into two groups; medical management and surgical management groups and all of data compared between in this groups. RESULTS Of ninety-six patients with infectious orbital cellulitis, 23 cases (14 male, 9 female) were included. Five patients (21.7%) were managed medically and 18 patients (78.3%) were managed surgically. Patients' age range was 5-70 years old. Most common location for non-medial cellulitis was superior space (66.7% in surgical and 40% in medical group; p = 0.511). In 13 cases of surgical group (72.3%) were detected microorganisms. The mean ± SD of collection volume in medical group were 476.5 ± 290.93 mm3 and 2572.94 ± 1075.75 mm3 in surgical group (p < 0.001). Ten patients in surgical group had compressive optic neuropathy. The mean ± SD of collection volume was 3204.97 ± 879.88 mm3 in patient with compressive optic neuropathy and 1280.43 ± 880.68 mm3 in patient without compressive optic neuropathy (P < 0.001). One case complicated by subdural empyema and another case progressed to necrotizing fasciitis. CONCLUSION Non-medial orbital cellulitis is an uncommon but sight-threatening and life-threatening condition. Timely diagnosis and accurate management reduce morbidity and mortality. Combined surgery for patients with superior or supra-temporal and large non-medial abscess is recommended.
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Affiliation(s)
| | - Masoomeh Eghtedari
- Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahla Hosseini
- Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Shirvani
- Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Atefeh Talebi
- Biostatistician of Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasrin Masihpoor
- Infectious Ophthalmologic Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sahar Mohaghegh
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical sciences and health services, Tehran, Iran
| | | | - Mohammad Hosseini
- Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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26
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Landeen KC, Mallory PW, Cervenka BP. Bilateral Ocular Necrotizing Fasciitis in an Immunosuppressed Patient on Prescription Eye Drops. Cureus 2020; 12:e9129. [PMID: 32789070 PMCID: PMC7417090 DOI: 10.7759/cureus.9129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Preseptal cellulitis is an infection of ocular tissue that is often unilateral and caused by extension of sinonasal disease. In rare instances it can lead to life-threatening necrotizing fasciitis. We present here a unique case of bilateral preseptal cellulitis incited by local conjunctivitis caused by prescription eye drops. The patient was immunosuppressed, which allowed her local inflammation to progress to severe infection and, ultimately, to necrotizing fasciitis. This necessitated serial debridement by ophthalmology and otolaryngology teams and a prolonged course of intravenous antibiotics monitored by an infectious disease team. Despite these interventions, the patient’s vision did not return to baseline and she had persistent cosmetic and functional deformity. This case is unique due to the inciting incident of new prescription eye drops, the patient’s immunosuppressed state leading to severity of infection, and the severe bilateral disease burden.
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Affiliation(s)
- Kelly C Landeen
- Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - Paul W Mallory
- Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, USA
| | - Brian P Cervenka
- Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, USA
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27
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Würtz NS, Mikkelsen LH, Jørgensen JS, Hansen MS, Madsen MB, Hyldegaard O, Heegaard S. Periocular necrotizing soft tissue infection in Greater Copenhagen. Acta Ophthalmol 2020; 98:207-212. [PMID: 31359628 DOI: 10.1111/aos.14205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/07/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE Necrotizing soft tissue infection, also known as necrotizing fasciitis (NF), is a fast-spreading life-threatening infection that most commonly affects the lower limbs, groin, or abdomen. Periocular necrotizing fasciitis (PNF) is rare. Limited data exist on PNF immune cell subset; hence, this study aims to determine the representation of immune cell subsets in patients diagnosed with PNF using immunohistochemical stainings. METHODS All patients diagnosed with PNF at Copenhagen University Hospital from 2008 to 2018 were included. Their electronic medical records and pathology reports were assessed, and available tissue specimens were reviewed and stained with monoclonal antibodies for CD1a+ Langerhans' cells, CD3+ T lymphocytes, CD15+ granulocytes, CD44+ lymphohematopoietic cells, CD68+ histiocytes, CD79α+ B lymphocytes, and FXIIIa+ dendritic macrophages and Langerhans' cells. The number of positive cells was counted, and an average score was calculated. The location of immune cells and bacteria was assessed. RESULTS The specimens were characterized by acute inflammation and necrosis of the fascia, while striated muscle involvement was less frequent. Haemolytic group A streptococci and Staphylococcus aureus were identified and mainly located in the deep dermis and subcutis in close relation to the fascia. Only few areas harboured both bacteria and inflammatory cells. Granulocytes, histiocytes and CD44+ lymphohematopoietic cells were demonstrated to be abundant in all patients, while B and T lymphocytes, dendritic macrophages and Langerhans' cells were less frequent. CONCLUSION The immune cell subsets found in this study of PNF were consistent with those identified in the literature on NF in other anatomical locations. This study concludes that immune cells are abundant and exhibit a typical pattern in PNF.
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Affiliation(s)
- Natacha Storm Würtz
- Department of Pathology Eye Pathology Section Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Lauge Hjorth Mikkelsen
- Department of Pathology Eye Pathology Section Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | | | - Michael Stormly Hansen
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Martin Bruun Madsen
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Ole Hyldegaard
- Hyperbaric Unit Department of Anesthesia Center for Head and Orthopedics Rigshospitalet Copenhagen Denmark
- Institute of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Steffen Heegaard
- Department of Pathology Eye Pathology Section Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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28
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Chou PY, Hsieh YH, Lin CH. Necrotizing fasciitis of the entire head and neck: Literature review and case report. Biomed J 2020; 43:94-98. [PMID: 32200961 PMCID: PMC7090320 DOI: 10.1016/j.bj.2019.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/31/2018] [Accepted: 08/11/2019] [Indexed: 12/20/2022] Open
Abstract
Necrotizing fasciitis (NF) is uncommon but potentially lethal when it is associated with systemic disorders. We report a case of odontogenic NF in a patient with uncontrolled diabetes mellitus. The patient was referred on day 10 since the onset of odontogenic NF. Protective tracheostomy, local facial-cervical fasciotomy were conducted and broadspectrum antibiotics were given, subsequent serial surgical drainage and debridement were performed in theater. Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumonia were isolated. Five staged debridements were performed to the targeted anatomic regions thus reducing surgical time and blood loss. The patient survived the acute infection and received subsequent reconstruction. Cervical NF with descending mediastinitis and periorbital NF is associated with high mortality rates. This is the only known report of an adult who survived NF affecting entire scalp, periorbital, cervical, and thoracic region. Early diagnosis and staged surgical planning minimize morbidity and mortality from NF.
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Affiliation(s)
- Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Huan Hsieh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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29
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Use of telemedicine in the management of life-threatening periorbital necrotizing fasciitis in a remote community. CAN J EMERG MED 2019; 22:118-120. [DOI: 10.1017/cem.2019.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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30
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Sud R, Sharma P, Garg G, Takkar B, Khanduja S. Periorbital necrotizing fasciitis due to Klebsiella pneumoniae in an immunocompetent patient. Indian J Ophthalmol 2019; 67:1721-1722. [PMID: 31546531 PMCID: PMC6786228 DOI: 10.4103/ijo.ijo_360_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Rouli Sud
- Department of Ophthalmology, Kalpana Chawla Government Medical College, Karnal, India
| | - Pallavi Sharma
- Department of Ophthalmology, Kalpana Chawla Government Medical College, Karnal, India
| | - Gulshan Garg
- Department of Surgery, Kalpana Chawla Government Medical College, Karnal, India
| | - Brijesh Takkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sumeet Khanduja
- Department of Ophthalmology, Kalpana Chawla Government Medical College, Karnal, India
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31
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Tong Y, Mak M, Ho H, Poon T, Mak Y, Choi W. Necrotizing fasciitis of bilateral eyelids: A case report and review of the literature. SURGICAL PRACTICE 2019. [DOI: 10.1111/1744-1633.12381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yu‐Tai Tong
- Department of SurgeryTuen Mun Hospital Hong Kong
| | | | - Hiu‐Ching Ho
- Department of SurgeryTuen Mun Hospital Hong Kong
| | - Tai‐Lun Poon
- Department of SurgeryTuen Mun Hospital Hong Kong
| | - Yan‐Wah Mak
- Department of SurgeryTuen Mun Hospital Hong Kong
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32
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Ting CF, Lam J, Anastas C. Subgaleal haematoma as a cause of periorbital necrotising fasciitis: a case report. Orbit 2019; 39:143-146. [PMID: 31106630 DOI: 10.1080/01676830.2019.1606834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Subgaleal haematoma in adulthood and periorbital necrotising fasciitis are unusual occurrences that have not been reported together. We discuss the first observed case of a 35-year-old female with periorbital necrotising fasciitis postulated to be caused by subgaleal haematoma following head trauma that was successfully managed with antibiotics and surgery.
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Affiliation(s)
- Chloe Ft Ting
- Department of Ophthalmology, Fremantle Hospital, Perth, Australia
| | - Jonathan Lam
- Department of Ophthalmology, Fremantle Hospital, Perth, Australia
| | - Con Anastas
- Department of Ophthalmology, Fremantle Hospital, Perth, Australia
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Placinta IA, España-Gregori E, Rodrigo-Hernández A, Martínez-Rubio C, Safont-Albert J, Bort-Martí MÁ. Periorbital necrotising fasciitis secondary to scratching. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2019; 94:242-247. [PMID: 30733068 DOI: 10.1016/j.oftal.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
An 80 year-old woman with no relevant medical history, consulted for worsening of right palpebral itching and pain after an insect bite. Her eyelids had areas of laceration due to scratching, which rapidly progressed to fibrinoid necrosis over the first 24hours. Lesions were cultivated, revealing Streptococcus pyogenes and Staphylococcus aureus. The patient was admitted to hospital with the diagnosis of periorbital necrotising fasciitis, in order to receive treatment with intravenous ceftriaxone, linezolid, and immediate surgical debridement. She remained in hospital for 17 days. Daily wound management consisted of debridement of necrotic remains, disinfection with chlorhexidine, and wound dressing with mupirocin, sulfadiazine, and miconazole ointments. The patient suffered streptococcal toxic shock syndrome, but she recovered over the first week. Palpebral reconstruction was performed on day 15, consisting of a preauricular total thickness skin graft for the superior eyelid, and lateral malar advancement to cover the lower eyelid. Adequate cosmetic and functional results were obtained.
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Affiliation(s)
- I A Placinta
- Servicio de Oftalmología, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, España.
| | - E España-Gregori
- Servicio de Oftalmología, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, España
| | - A Rodrigo-Hernández
- Servicio de Oftalmología, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, España
| | - C Martínez-Rubio
- Servicio de Oftalmología, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, España
| | - J Safont-Albert
- Servicio de Cirugía Plástica, Estética y Reparadora, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, España
| | - M Á Bort-Martí
- Servicio de Oftalmología, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, España
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A Patient With Periorbital Necrotizing Fasciitis by Klebsiella pneumoniae. J Craniofac Surg 2019; 30:e245-e247. [DOI: 10.1097/scs.0000000000005199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Vichitvejpaisal P, Dalvin LA, Lally SE, Shields CL. Delayed implant infection with Cutibacterium acnes ( Propionibacterium acnes) 30 years after silicone sheet orbital floor implant. Orbit 2019; 39:139-142. [PMID: 31021283 DOI: 10.1080/01676830.2019.1605613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To report a case of delayed implant infection with Cutibacterium acnes (C. acnes, previously known as Propionibacterium acnes) 30 years after silicone sheet orbital floor implant.Methods: Case report with orbital imaging.Results: A 61-year-old male with a history of traumatic orbital floor fracture right eye (OD) repaired using a silicone sheet orbital floor implant 30 years prior, presented with 6 months of painless blepharoptosis and diplopia OD. On examination, there was 3 mm right upper eyelid blepharoptosis and hyperglobus. There was no globe proptosis, dysmotility, or compression and no cutaneous erythema, hyperthermia, discharge, or tenderness to palpation. Orbital magnetic resonance imaging (MRI) revealed a cystic mass in the inferior orbit in the region of the floor implant, measuring 25 mm in diameter and 10 mm in thickness. By MRI, T1-weighted images revealed a hypointense signal within the mass and T2-weighted images showed hyperintense signal with a flat hypointensity centrally representing the floor implant. Microbiologic cultures grew C. acnes.Conclusions: C. acnes can manifest several decades after placement of an orbital prosthetic implant, leading to delayed infection.
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Affiliation(s)
- Pornpattana Vichitvejpaisal
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA.,Chulabhorn Royal Academy, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Bangkok, Thailand
| | - Lauren A Dalvin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Sara E Lally
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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Cereceda-Monteoliva N, Lewis H, Al-Himdani S, Stone C. Periorbital necrotising fasciitis with underlying undiagnosed hepatitis C infection. BMJ Case Rep 2019; 12:e223720. [PMID: 31015232 PMCID: PMC6506045 DOI: 10.1136/bcr-2017-223720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 11/04/2022] Open
Abstract
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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Affiliation(s)
| | - Hannah Lewis
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Nadal J, Galatoire O, Laouar K, Jeanjean L, Villain M, Audemard D, Daien V. Periorbital necrotizing fasciitis without initial trauma: A rare case report. J Fr Ophtalmol 2019; 42:e209-e211. [PMID: 30979555 DOI: 10.1016/j.jfo.2018.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/20/2018] [Indexed: 10/27/2022]
Affiliation(s)
- J Nadal
- Department of ophthalmology, Nîmes university hospital, CHU de Nîmes, 4, rue du Pr-Debré, 30029 Nîmes cedex 9, France; I2FH, institut d'imagerie fonctionnelle humaine, Gui de Chauliac hospital, Montpellier university hospital center, 34295 Montpellier, France.
| | - O Galatoire
- Service de chirurgie plastique et reconstructrice ophtalmologique, Fondation Rothschild Paris, 75019 Paris, France
| | - K Laouar
- Department of ophthalmology, Nîmes university hospital, CHU de Nîmes, 4, rue du Pr-Debré, 30029 Nîmes cedex 9, France
| | - L Jeanjean
- Department of ophthalmology, Nîmes university hospital, CHU de Nîmes, 4, rue du Pr-Debré, 30029 Nîmes cedex 9, France
| | - M Villain
- Department of ophthalmology, Gui De Chauliac hospital, 34000 Montpellier, France
| | - D Audemard
- Department of ophthalmology, Nîmes university hospital, CHU de Nîmes, 4, rue du Pr-Debré, 30029 Nîmes cedex 9, France
| | - V Daien
- Department of ophthalmology, Gui De Chauliac hospital, 34000 Montpellier, France; Inserm, neuropsychiatry: epidemiological and clinical research, university Montpellier, 34090 Montpellier, France
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Herdiana TR, Takahashi Y, Valencia MRP, Ana-Magadia MG, Kakizaki H. Periocular Necrotizing Fasciitis with Toxic Shock Syndrome. Case Rep Ophthalmol 2018; 9:299-303. [PMID: 29928226 PMCID: PMC6006621 DOI: 10.1159/000488971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/04/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose To report a case of periocular necrotizing fasciitis with toxic shock syndrome. Methods This is a case report of a previously healthy 69-year-old woman with left preseptal eyelid infection that spread rapidly and deteriorated into necrosis of the eyelid with toxic shock syndrome. She was admitted to intensive care unit for hemodynamic stabilization. Results Intravenous antibiotic and high-dose immunoglobulin were administered followed by surgical debridement. Rehabilitative eyelid reconstruction was performed after acute episode, resulting in patient satisfaction in relation to periocular function and appearance. Conclusion We reported a case of periocular necrotizing fasciitis with toxic shock syndrome that necessitated early aggressive medical treatment and adequate surgical intervention to decrease morbidity and mortality. A high level of suspicion of periocular necrotizing fasciitis is necessary to make a prompt diagnosis.
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Affiliation(s)
- Tri Rejeki Herdiana
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Ma Regina Paula Valencia
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Marian Grace Ana-Magadia
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
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Setiawati W, Satari HHI, Irawati Y, Susiyanti M. Successful management of bilateral periorbital necrotising fasciitis with ocular involvement. BMJ Case Rep 2018; 2018:bcr-2017-223457. [PMID: 29545431 DOI: 10.1136/bcr-2017-223457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 4-year-old girl had suffered from multiple pustules and severely swollen eyelids for a week which led to difficulties in opening her eyes. The pustules burst 2 days prior to admission, causing blood and pus to come out. As a result, the evaluation of eye movement, visual acuity and intraocular pressure was hindered. Eyelids were spasming, hyperaemic, warm and of soft consistency on palpation. Crust and necrotic tissues were also observed. The patient had a history of fever with cough and nasal congestion. CT scan revealed soft tissue thickening on bilateral anterolateral periorbital region. She also underwent debridement in both eyelids, followed by partial periosteal graft on the left eye due to corneal perforation. During follow-up after 1.5 months, she also underwent excision of the periosteal graft and synechiolysis, followed by cataract extraction of the left eye.
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Affiliation(s)
- Laura Leach
- Department of Otorhinolaryngology, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Chloe Swords
- Department of Otorhinolaryngology, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Nazir Bhat
- Department of Otorhinolaryngology, North West Anglia NHS Foundation Trust, Peterborough, UK
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Jaffer ZN, Nicholson C. Bullous eyelid. BMJ Case Rep 2018; 2018:bcr-2017-220962. [PMID: 29472418 DOI: 10.1136/bcr-2017-220962] [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: 11/03/2022] Open
Abstract
Periocular necrotising fasciitis is a rare but sight-threatening condition, which relies on clinical judgement to detect in a timely manner. A 51-year-old woman presented to a rural hospital with rapid onset bilateral eye swelling, erythema and pain and was started on broad spectrum intravenous antibiotics. Upon admission, she became septic and required fluid resuscitation and transfer to a higher level of care. She received debridement and continued intravenous antibiotics, with step down to oral when clinically stable. Rapid recognition and treatment of her condition resulted in a positive outcome.
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Affiliation(s)
- Zahra N Jaffer
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.,Family Medicine, Weeneebayko Area Health Authority, Moose Factory, Canada
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Deneubourg DL, Catherine Z, Lejuste P, Breton P. Periorbital Necrotizing Fasciitis Induced by Streptococcus pyogenes : A Case Report and Clarification. J Oral Maxillofac Surg 2018; 76:154.e1-154.e5. [DOI: 10.1016/j.joms.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 11/30/2022]
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An aggressive and fatal craniofacial group A Streptococcus infection resulting from a minimally displaced orbital floor fracture. Int J Oral Maxillofac Surg 2018; 47:133-136. [DOI: 10.1016/j.ijom.2017.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/04/2017] [Accepted: 07/20/2017] [Indexed: 11/18/2022]
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Periorbital Necrotizing Fasciitis Secondary to Candida parapsilosis and Streptococcus pyogenes. Ophthalmic Plast Reconstr Surg 2017; 33:S31-S33. [PMID: 25902389 DOI: 10.1097/iop.0000000000000476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Necrotizing fasciitis is most often caused by either polymicrobial bacterial infections or by Gram-positive organisms, such as Streptococcus or Staphylococcus; however, rare cases of fungal necrotizing fasciitis have been reported. Candida parapsilosis is an emerging fungal pathogen. This fungus grows in either a yeast or pseudohyphal form. C. parapsilosis has been reported to cause keratitis, intraocular infection, and seeding of frontalis slings. C. parapsilosis is a commensal of human skin and can be acquired by nosocomial spread. Necrotizing fasciitis due to Candida has rarely been reported, but to date C. parapsilosis has not been identified as the causative organism in necrotizing fasciitis. This is the first documented case of human periocular soft tissue infection by C. parapsilosis, and also the first report providing evidence of mycotic infection in a necrotizing fasciitis concurrently infected by Streptococcus pyogenes.
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Necrotizing Fasciitis of the Periorbital Region Complicated by Combined Central Retinal Artery Occlusion, Central Retinal Vein Occlusion, and Posterior Ciliary Occlusion. Ophthalmic Plast Reconstr Surg 2017; 33:e75-e76. [PMID: 27556345 DOI: 10.1097/iop.0000000000000770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 50 year-old man on immunosuppressive agents presented with left eye vision loss, periorbital swelling, pain, and ophthalmoplegia. The patient was clinically found to have a central retinal artery and vein occlusion. A CT scan was performed which demonstrated intraorbital fat stranding, however the patient lacked sinus disease. The etiology of the orbital infection was held in question. The area was debrided in the operating room, and the specimen demonstrated group A streptococcal species consistent with necrotizing fasciitis. Periorbital necrotizing fasciitis should be suspected in patients with rapidly progressive orbital symptoms without sinus disease as lack of surgical intervention can result in poor outcomes. The unusual aspect to this case is the mechanism of vision loss, as the authors hypothesize that there was vascular infiltration of the infection resulting in the central retinal artery occlusion and central retinal vein occlusion which have not been previously reported secondary to necrotizing fasciitis of the orbit.
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Proia AD. Periocular necrotizing fasciitis in an infant. Surv Ophthalmol 2017; 63:251-256. [PMID: 28300549 DOI: 10.1016/j.survophthal.2017.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 11/18/2022]
Abstract
Periocular necrotizing fasciitis developed in a 12-month-old boy with swelling of both eyes and redness and a discharge from the left eye approximately 36 hours after blunt trauma. Computed tomography revealed preseptal and soft-tissue edema on the left side, but no signs of orbital involvement, orbital fractures, or drainable abscess in the anterior left lower eyelid. The inflammatory signs worsened over the next day, and there was purulent discharge from the left lower eyelid and an abscess and necrosis of the lower eyelid skin. He did well following surgical debridement and treatment with intravenous antibiotics. His course highlights the difficulty in diagnosing necrotizing fasciitis and the necessity for prompt surgical debridement and empirical broad-spectrum antibiotic therapy.
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Affiliation(s)
- Alan D Proia
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA.
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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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Necrotising fasciitis of the paranasal sinuses. Eur Arch Otorhinolaryngol 2016; 274:1751-1760. [DOI: 10.1007/s00405-016-4148-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/13/2016] [Indexed: 01/17/2023]
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Abstract
PURPOSE To describe the clinical features associated with periorbital necrotizing fasciitis and to correlate these features with clinical outcomes. METHODS The case logs of 3 surgeons were used to identify cases of necrotizing fasciitis. Chart reviews were performed to characterize clinical metrics, and statistical analyses were performed. RESULTS Seventeen patients (9 males, 8 females; mean age = 48.1 years, standard deviation = 22.6 years) were identified with periorbital necrotizing fasciitis. Of these patients, 52.9% did not have immunodeficiencies, and 52.9% did not have antecedent trauma or infected facial lesions. One patient died from necrotizing fasciitis. A history of immunosuppression correlated with the requirement for exenteration, but did not correlate visual acuity of worse than 20/40 upon discharge from the hospital. Most of the patients (68.75%) were discharged with visual acuity of better than 20/40 in the affected eye. CONCLUSIONS This study represents the largest case series of patients with periorbital necrotizing fasciitis. Most of the patients in this series did not have immunodeficiencies, and the majority were discharged with favorable visual acuities. Nonetheless, a history of immunosuppression correlated with the need for exenteration, but was not statistically linked with worse visual outcomes.
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50
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Abdul Kadir N, Ahmad SS, Abdul Ghani S, Paramananda M. A case of acute periorbital necrotizing fasciitis. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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