SHM Converge Scientific Abstract ePoster Gallery-Fascia on Fire: A Case of Periorbital Necrotizing Fasciitis.

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A 54-year-old man without diabetes presented with 2 days of painful swelling of the left upper and lower eyelids, followed by purulent discharge and inability to open the eye. Exam showed erythema, ecchymosis, superficial blisters, tenderness, and no crepitus. Laboratory studies revealed severe inflammation and sepsis markers, including WBC 80,000, lactate 4 mmol/L, CRP 96 mg/L, and ESR 92 mg/L.<br /><br />Initial and repeat contrast CT scans of the orbits showed progressive left periorbital soft tissue swelling but no gas or fascial fluid collections, suggesting preseptal cellulitis and not confirming necrotizing infection. Despite negative imaging, the skin became darker and began to slough, increasing suspicion for necrotizing fasciitis. Ophthalmology performed debridement, which confirmed periorbital necrotizing fasciitis.<br /><br />He was treated with broad-spectrum antibiotics, including vancomycin, ceftriaxone, then vancomycin, piperacillin-tazobactam, and clindamycin for toxin suppression. Wound cultures eventually grew penicillin-susceptible Streptococcus pyogenes and methicillin-resistant Staphylococcus aureus. After 7 days of IV vancomycin and more than 20 wound debridements, he was discharged on 2 weeks of oral linezolid.<br /><br />This case highlights that early periorbital necrotizing fasciitis may not show classic CT findings, and that rapid clinical progression and skin necrosis should prompt urgent surgical evaluation and treatment.

Asset Subtitle

Katsiaryna Murashka

Meta Tag

Author List Julia Torrellas, Katsiaryna Murashka, Violetta Laskova

Category Clinical Vignettes

Concept Periorbital Necrotizing Fasciitis

Concept Clinical Suspicion

Concept Surgical Evaluation

Concept Debridement

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, New York

Presenting Author Katsiaryna Murashka

Track Adult

Keywords

periorbital necrotizing fasciitis

preseptal cellulitis

eyelid swelling

Streptococcus pyogenes

MRSA

sepsis

contrast CT orbit

surgical debridement

clindamycin

linezolid

Periorbital Necrotizing Fasciitis

Clinical Suspicion

Surgical Evaluation

Debridement