Periorbital necrotising fasciitis secondary to scratching.

Autores de IIS La Fe

• Ioan Alexandru Placinta Tat

  Autor

• Enrique España Gregori

  Autor

• Clara Martinez Rubio

  Autor

• Julian Safont Albert

  Autor

• María Ángeles Bort Martí

  Autor

Participantes ajenos a IIS La Fe

• Rodrigo-Hernández A

Grupos

• Investigación en Neuroinmunología y Esclerosis Múltiple

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.

Keywords

• Fascitis necrosante periorbitaria, Insect bite, Linezolid, Periorbital necrotising fasciitis, Picadura de insecto, Rascado, Scratching, Streptococcal toxic shock syndrome, Streptococcus pyogenes, Síndrome de shock tóxico estreptocócico