An Eye Popping Case of Orbital Necrotizing Fasciitis Treated with Antibiotics, Surgery, and Hyperbaric Oxygen Therapy

Singam, Narayana Sarma V.; Rusia, Deepam; Prakash, Rajan

doi:10.12659/ajcr.902535

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…The primary treatment for NF is surgical debridement of the wound as soon as possible [1][2][3][4][5][6][7][8][9][10]. Some researchers have noted that NF can be effectively treated with intravenous antibiotic therapy alone (Hooi et al) [4].…”

Section: Discussionmentioning

confidence: 99%

“…There have been studies that show hyperbaric therapy as a beneficial addition to the patient's treatment [9]. The intravenous administration of immunoglobulin G (IVIG) in the treatment of NF remains controversial [9].…”

Section: Discussionmentioning

confidence: 99%

“…Necrotizing fasciitis (NF) is the most common necrotizing soft tissue infection (NSTI) [1]. NF is a bacterial infection with a high mortality rate; that leads to the rapid destruction of the muscle fascia and subcutaneous adipose tissue [1][2][3][4][5][6][7][8][9][10]. The incidence of NF is estimated at 0.3 to 15 cases per 100.000.000 population [1].…”

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confidence: 99%

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Unilateral Periorbital Necrotizing Fasciitis – A Case Report

Trepka-Sirek,

Sirek,

Mrukwa-Kominek

et al. 2023

Okulistyka

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IntroductionPeriorbital necrotizing fasciitis is rare due to the excellent blood supply to the area, but nevertheless can sometimes lead to death. Knowledge of the symptoms of the disease enables rapid diagnosis, which reduces the possibility of serious complications of the disease and its mortality. To date, few publications describing the disease entity have been presented.Patient descriptionA 70-year-old male patient was admitted to the hospital with necrotizing fasciitis of the left upper eyelid region, diagnosed on the basis of fulminant development of necrosis and a positive bacteriological test for S. pyogenes.ResultsContrast-enhanced computed tomography showed the presence of a pathological inflammatory infiltrate within the eyelid of the left eye and subcutaneous tissue at the preseptal level of the orbit and left cheek. Blood tests showed leukocytosis (total white blood cell count of 17.33 x 109/ L with 87.1% neutrophils) and elevated C reactive protein parameters (240.64 mg/ L). Empirical intravenous antibiotic therapy was administered: 1 g of amoxicillin with 200 mg of clavulanic acid every 8 hours, 500 mg of metronidazole every 8 hours, and ciprofloxacin into the left and right conjunctival sacs 3 mg/ml every 6 hours. Surgical debridement of upper eyelid necrosis was performed on the second day of hospitalization.ConclusionsThe peculiar anatomical structure of the periocular region promotes the dynamic development of necrotizing fasciitis. The close proximity of the central nervous system and the eyeball threatens irreversible consequences, including loss of vision or death. Early appropriate targeted treatment can effectively stop the development of the disease and prevent severe complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Unilateral Periorbital Necrotizing Fasciitis – A Case Report

Trepka-Sirek,

Sirek,

Mrukwa-Kominek

et al. 2023

Okulistyka

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“…Broad spectrum antibiotics can mask the NF and contribute to the misdiagnosis of the disease, leading to catastrophic results, since treatment including only antibiotics leads to 100% mortality [10,11] . In the present case the patient was still under broad spectrum antibiotics, but obviously it did not help him a lot.…”

Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis after abdominal trauma: A case report

Fortis¹,

Kaldis²,

Spyropoulou³

et al. 2021

Int. J. Phys. Educ. Sports Health

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A case of a lower extremity necrotizing fasciitis (NF) in a young patient operated for liver trauma, having no visible skin wounds, discussed and correlated to the present literature. The patient was admitted to the Hospital after a road traffic accident (RTA). From the Past Medical History (PMH) he referred a history of lymphoma which was successfully treated. Initially he was diagnosed with a liver rupture and no other concomitant injuries. He was operated and admitted to the Intensive Care Unit (ICU). An abscess complicated the initial operation which was promptly drained. He then developed skin necrosis of the right lower extremity. During the operation the muscles looked viable. The skin, subcutaneous fat and fasciae were extensively necrotized. Lhrinec score was 8 and cultures showed fungal development. Necrotizing fasciitis (NF) was the most probable diagnosis. After having successive operations on the leg, the NF was disseminated and the patient died. Necrotizing fasciitis is rare in young patients with no predisposing factors, such as Diabetes Mellitus, active cancer and renal disease. In the present case the successive operations, massive blood transfusion and possibly the history of a Lymphoma could have played a role in this rare and frequently fatal condition.

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“…Orbital and preseptal abscesses are SSTIs commonly caused by Staphylococcus aureus (61,62), and MRSA rates appear to be rising (63). Severe cases have been reported, including orbital and periorbital necrotizing fasciitis (64)(65)(66), necrotizing conjunctivitis with orbital invasion (12) and orbital cellulitis with bilateral involvement that progressed to blindness (14). A prospective study (2012-2015) of children and adolescents presenting with staphylococcal periorbital and orbital cellulitis in Houston found that most of the S. aureus isolates in their population were methicillin-resistant (67%) and were genetically related to the USA300 clone (78%) (67).…”

Section: Discussionmentioning

confidence: 99%

Hospital-Associated Multidrug-Resistant MRSA Lineages Are Trophic to the Ocular Surface and Cause Severe Microbial Keratitis

Bispo

Ung

Chodosh

et al. 2020

Front. Public Health

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Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of severe and difficult to treat ocular infection. In this study, the population structure of 68 ocular MRSA isolates collected at Massachusetts Eye and Ear between January 2014 and June 2016 was assessed. By using a combination of multilocus sequence typing (MLST) analysis, SCCmec typing and detection of the panton-valentine leukocidin (PVL) gene, we found that the population structure of ocular MRSA is composed of lineages with community and hospital origins. As determined by eBURST analysis of MLST data, the ocular MRSA population consisted of 14 different sequence types (STs) that grouped within two predominant clonal complexes: CC8 (47.0%) and CC5 (41.2%). Most CC8 strains were ST8, harbored type IV SCCmec and were positive for the PVL-toxin (93.7%). The CC5 group was divided between strains carrying SCCmec type II (71.4%) and SCCmec type IV (28.6%). Remaining isolates grouped in 6 different clonal complexes with 3 isolates in CC6 and the other clonal complexes being represented by a single isolate. Interestingly, major MRSA CC5 and CC8 lineages were isolated from discrete ocular niches. Orbital and preseptal abscess/cellulitis were predominantly caused by CC8-SCCmec IV PVL-positive strains. In contrast, infections of the cornea, conjunctiva and lacrimal system were associated with the MDR CC5 lineage, particularly as causes of severe infectious keratitis. This niche specialization of MRSA is consistent with a model where CC8-SCCmec IV PVL-positive strains are better adapted to cause infections of the keratinized and soft adnexal eye tissues, whereas MDR CC5 appear to have greater ability in overcoming innate defense mechanisms of the wet epithelium of the ocular surface.

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An Eye Popping Case of Orbital Necrotizing Fasciitis Treated with Antibiotics, Surgery, and Hyperbaric Oxygen Therapy

Cited by 7 publications

References 17 publications

Unilateral Periorbital Necrotizing Fasciitis – A Case Report

Unilateral Periorbital Necrotizing Fasciitis – A Case Report

Necrotizing fasciitis after abdominal trauma: A case report

Hospital-Associated Multidrug-Resistant MRSA Lineages Are Trophic to the Ocular Surface and Cause Severe Microbial Keratitis

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