Orbital Necrotizing Fasciitis in a Middle-Aged Man: A Rare and Aggressive Presentation
Author: Ruba Aladwan
Base Hospital / Institution: Broomfield university hospital
ePoster presentation
Abstract ID: 25-314
Purpose
To report a rare case of orbital necrotizing fasciitis in a previously healthy adult male, highlighting diagnostic challenges, management strategies, and clinical outcomes.
Methods
Methods:
Case report and literature review.
Results
A 46-year-old homeless male presented with a one day history of visual loss in the right eye, severe pain and acute periorbital swelling. He has no known medical conditions apart from alcohol-dependence. His vision in the right eye was no perception of light, intraocular pressure 60mmHg. The orbit was very tense, with gross proptosis, florid chemosis and complete ophthalmoplegia. Turbid, foul-smelling discharge, skin blistering and laboratory parameters raised suspicion of necrotising fasciitis. Emergency surgical debridement was performed and examination under anaesthesia revealed a central retinal artery occlusion. Fluid cultures grew beta-hemolytic group A Streptococcus sensitive to multiple antibiotics. Despite initial clinical improvement on multiple broad-spectrum intravenous antibiotics, his orbital signs recurred, his CRP and white count again showed an upgoing trend. Black eschars were noted on his peripheries as evidence of necrotic systemic septic emboli. Further debridement of peri-orbital tissue was undertaken and after 2 weeks of intravenous antimicrobial therapy the patient showed gradual improvement.
Conclusion
Orbital necrotizing fasciitis with visual loss from central retinal artery occlusion is a rare presentation of an aggressive condition. This case underscores the need for a high index of clinical suspicion and early surgical intervention to limit the ocular morbidity associated with extensive periocular tissue loss, and pre-empt systemic complications.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Lee | Tan | Broomfield university hospital |
| Kushnuda | Kuzhorova | Broomfield university hospital |
