Concurrent Pseudomonas Periorbital Necrotizing Fasciitis and Endophthalmitis: A Case Report and Literature Review

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.

Periorbital Facial Necrotizing Fasciitis in Adults: A Rare Severe Disease with Complex Diagnosis and Surgical Treatment—A New Case Report and Systematic Review

“…Necrotizing fasciitis is a severe condition with a rapid course and high mortality risk (35%) [14][15][16][17]. Periocular involvement is rarely reported in the literature, being both uncommon and debilitating, sometimes resulting in the need for exenteration of the affected eye globe [4,11,18,19].…”

Unusual cause of bilateral periocular ulceronecrotic wound: Tetracaine abuse‐associated bullous drug eruption

“…5,6 Diagnosing BDE can be challenging, as it requires a careful evaluation of the patient's clinical history, physical examination findings, and, in some cases, microbiological and histopathological examination. 7 Management of localized BDE involves the identification and discontinuation of the causative drug. In this case, topical tetracaine abuse was recognized as the culprit drug, and the patient was advised to refrain from further use.…”

“…Diagnosing BDE can be challenging, as it requires a careful evaluation of the patient's clinical history, physical examination findings, and, in some cases, microbiological and histopathological examination. 7 …”

Treatment of tissue necrosis with hyperbaric oxygen therapy in a patient with pseudomonas endophthalmitis and orbital cellulitis: a case report

“…P. aeruginosa endophthalmitis often results in a poor visual prognosis despite intravitreal and systemic antibiotic therapy and may result in enucleation or evisceration in 64% [ 2 ]. Despite endophthalmitis treatment, catastrophic soft tissue infections such as orbital cellulitis, ocular necrotizing fasciitis, periorbital gangrene, and eyelid necrosis caused by P. aureginosa have been reported [ 3 , 4 ].…”