Fascitis necrosante periocular

La fascitis necrosante es una enfermedad rara y potencialmente mortal, que se produce por una infección grave que se disemina desde las fascias superficiales destruyendo el tejido celular subcutáneo y la piel suprayacente. Las formas perioculares de la enfermedad son aún más raras y pueden tener graves consecuencias para el paciente. El objetivo de este estudio fue contrastar los hallazgos clínicos y los resultados terapéuticos en una serie de cuatro casos diagnosticados en el Centro Oftalmológico de Holguín en el curso de cinco años. Entre 2017 y 2022 se diagnosticaron cuatro pacientes con formas perioculares de fascitis necrosante en el Centro Oftalmológico de Holguín. Dos pacientes tuvieron antecedentes de trauma menor. El dolor predominó entre los síntomas locales. Se identificaron dos patrones de lesiones: bilateral con ulceración y afectación de la región palpebral superior y unilateral con extensión en ambos párpados y apariencia oscura de la piel. Los pacientes evolucionaron a la gravedad con deterioro del estado general. El desbridamiento del tejido necrótico y el tratamiento con antibióticos de amplio espectro permitieron detener el progreso de la enfermedad, aunque quedaron secuelas anatómicas y funcionales. Un paciente falleció como consecuencia de una leucemia diagnosticada durante su ingreso. El reconocimiento temprano de la fascitis necrosante periocular y su inmediato tratamiento es indispensable para garantizar resultados óptimos y la supervivencia del paciente. Las formas perioculares pueden tener apariencia clínica diversa, lo que debe ser tenido en cuenta ante la sospecha de este cuadro, sobre todo por la similitud inicial con la celulitis preseptal.

Necrotizing fasciitis is a rare and potentially fatal disease caused by a severe infection that spreads from the superficial fasciae destroying the subcutaneous cellular tissue and overlying skin. Periocular forms of the disease are even rarer and can have serious consequences for the patient. The aim of this study was to contrast clinical findings and therapeutic outcomes in a series of four cases diagnosed at the Holguin Ophthalmology Center over the course of five years. Between 2017 and 2022, four patients with periocular forms of necrotizing fasciitis were diagnosed at the Holguín Ophthalmologic Center. Two patients had a history of minor trauma. Pain predominated among the local symptoms. Two patterns of lesions were identified: bilateral with ulceration and involvement of the upper palpebral region and unilateral with extension in both eyelids and dark appearance of the skin. Patients progressed to severity with deterioration of general condition. Debridement of necrotic tissue and treatment with broad-spectrum antibiotics halted disease progression, although anatomical and functional sequelae remained. One patient died as a result of leukemia diagnosed during his admission. Early recognition of periocular necrotizing fasciitis and its immediate treatment is essential to ensure optimal outcome and patient survival. Periocular forms can have different clinical appearances, which should be taken into account when suspecting this condition, especially due to the initial similarity with preseptal cellulitis.

Acute ptosis as a presentation of preseptal cellulitis leading to cerebral abscess in a patient with uncontrolled diabetes

@#Acute ptosis due to preseptal cellulitis requires urgent medical attention, as the infection can extend posteriorly into the orbit, leading to significant visual and cerebral complications. We report a case of a 58-year-old woman with uncontrolled diabetes mellitus presenting with acute ptosis due to preseptal cellulitis. After initial resolution of fever with intravenous amoxicillin-clavulanate, she experienced a seizure due to cerebral abscess a week later and was treated with intravenous ceftriaxone. Preseptal cellulitis is usually treated on an outpatient basis with oral antibiotics, as it rarely extends posteriorly to cause cerebral complications. We wish to highlight the importance of admitting patients with preseptal cellulitis in patients with uncontrolled diabetes for intravenous antibiotics due to the potential for visual and cerebral complications.

A Case of Thelazia callipaeda Infestation with Preseptal Cellulitis

PURPOSE: To report a case of Thelazia callipaeda infection with preseptal cellulitis. CASE SUMMARY: A 24-year-old female presented with symptoms of conjunctival injection and ocular pain in her left eye and a parasite was found in her conjunctival sac. Using light microscopy, we identified Thelazia callipaeda and many larvae were observed in the vulva of an adult female worm. Three days later, erythematous swelling occurred in the left upper eyelid and four adult worms were found and removed with forceps. Third-generation cephalosporin and nonsteroidal anti-inflammatory drugs were administered orally; the eyelid swelling improved but the conjunctival injection remained. Later five and seven adult worms were removed every 4 weeks and the conjunctival injection improved with no parasites detected after the final extraction. CONCLUSIONS: In the case of Thelazia callipaeda infection, it is necessary to identify eggs and larvae and to observe the patient for more than 1 month because of postextraction growth of the larvae. In addition, the possibility of preseptal cellulitis by Thelazia callipaeda should be considered.

Varicella zoster causing preseptal cellulitis – uncommon but possible

Background: Varicella has been known to be a harmless childhood disease. However, it hasbeen reported that severe complications have taken place following Varicella infection, in bothimmunocompetent, as well as immunocompromised, individuals. Cutaneous complications ofVaricella may manifest as preseptal cellulitis, albeit rarely.Report: We present a case of a 4-year-old boy who presented with symptoms and signs ofpreseptal cellulitis following Varicella infection. He was referred to the otorhinolaryngologyteam for a nasoendoscopy to rule out sinusitis, in view of the fear that a child presentingwith a swollen red eye may be a case of true orbital cellulitis. He was treated successfully withintravenous antibiotics and surgical drainage of the preseptal collection.Conclusion: It is imperative for clinicians to be aware that a simple Varicella infection may leadto cutaneous complications in the pediatric age group, especially in children who are 4 yearsand younger. They may develop preseptal cellulitis, whose presentation might mimic that oforbital cellulitis. Empirical treatment with antibiotics would be advantageous for the patient. Anasoendoscopic examination may also be warranted in these cases to rule out sinusitis as a causeof orbital cellulitis.

Clinical Features of Orbital Cellulitis in Children

PURPOSE: The present study reviews the clinical features of orbital cellulitis in childhood for early diagnosis and proper treatment. METHODS: The authors performed a retrospective study by computed tomography (CT) on children under 14 years of age diagnosed with orbital cellulitis and admitted to Pusan National University Hospital from 2003 to 2010. RESULTS: In total, 27 patients were identified (range 4 months to 14 years). Periorbital swelling was the most common initiating symptom, followed by fever and conjunctival injection. Paranasal sinus disease was the most common predisposing factor. Preseptal cellulitis was the most common finding, followed by subperiosteal abscess, orbital cellulitis, and orbital abscess. All patients underwent a blood culture; none were positive. Intravenous antibiotics therapy was performed empirically and was effective in all cases. No patients suffered from permanent complications except recurrence. CONCLUSIONS: Orbital cellulitis in children presents with periorbital swelling, fever, conjunctival injection in association with sinusitis, and upper respiratory infection (URI). A CT study is a reliable diagnostic option for the early detection and localization in the pediatric orbital cellulitis. Early empirical antibiotic therapy is mandatory for successful treatment.

Nine years’ review on preseptal and orbital cellulitis and emergence of community–acquired methicillin-resistant Staphylococus aureus in a tertiary hospital in India.

Context: Preseptal cellulitis is the commonest orbital disease which frequently needs to be differentiated from orbital cellulitis. Prompt diagnosis and treatment with appropriate antibiotics can prevent vision loss and life-threatening complications of orbital cellulitis. Aims: To describe the clinical profile of cases with preseptal and orbital cellulitis admitted to a tertiary care hospital during a period of nine years. The causative organisms and the clinical outcome were analyzed. Settings and Design: Retrospective descriptive case study done in a tertiary care hospital in South India. Material and Methods: The in-patient records of patients with preseptal and orbital cellulitis were reviewed from 1998 to 2006. The factors reviewed included ocular findings aiding in the distinction of the two clinical conditions, the duration of symptoms, the duration of hospital stay, microbiological culture report of pus or wound swab, blood culture, drugs used for treatment, the response to therapy and complications. Statistical Analysis Used: Descriptive analysis. Results: One hundred and ten cases, 77 patients with preseptal cellulitis and 33 patients with orbital cellulitis were reviewed. Five percent of children and 21% of adults presented with cutaneous anthrax contributing to preseptal cellulitis. Thirty-nine percent cases with orbital cellulitis were caused by methicillin-resistant Staphylococcus aureus (MRSA). Conclusions: This study has helped in identifying organisms which cause orbital infections, especially community-acquired MRSA. It indicates the need for modifying our empirical antimicrobial therapy, especially in orbital cellulitis.

Corneal Perforation with Preseptal Cellulitis in a Patient with Acute Lymphocytic Leukemia

We report a case of corneal perforation with preseptal cellulitis in a patient with acute lymphocytic leukemia (ALL). A 17-yr-old female patient who was undergoing combination chemotherapy for ALL was referred due to upper lid swelling and pain in the right eye for 2 days. Visual acuity in the right eye was 20/20. Initial examination showed no abnormal findings, other than swelling of the right upper eyelid. Computed tomography showed a finding of preseptal cellulitis. Microbiologic study of bloody and purulent discharge revealed Serratia marcescens. Corneal melting and perforation with iris prolapse were detected in the right eye on the 16th day. Emergent tectonic keratoplasty was performed. Seven months after surgery, visual acuity in the right eye was 20/300, and the corneal graft was stable.

Multiple Traumatic Pyomucocele

The mucocele of paranasal sinuses is a mucus-filled, epithelial-lined cystic structure resulting from the destruction of the sinus ostia secondary by recurrent inflammation, trauma or intrinsic disease. A 42-year-old man was presented with a left periorbital swelling that developed 7 days ago. CT scan revealed mass lesions with soft tissue density in the left anterior ethmoid and frontal sinus. MRI showed a well- demarcated cystic mass in the left anterior ethmoid sinus with a high signal on both the T1-weighted and T2-weighted images as well as in the left frontal sinus with a low signal on the T1-weighted images and a high signal on the T2- weighted images. The patient subsequently underwent the removal of the left anterior ethmoid and frontal mucocele via a Lynch's approach and a left endoscopic anterior ethmoidectomy. He has no recurrence 6 months after surgery.