Periorbital necrotizing fasciitis in a 69 year old patient. Medical management and use of hyperbaric oxygen as further adjunctive therapy

Abstract

AbstractPurpose To report a case of periorbital necrotizing fasciitis in a 69 year old patient that was successfully managed with the use of intravenous antibiotics and surgical debridement. In addition to the usual treatment modalities, Hyperbaric Oxygen (HBO) was used as further adjunctive therapyMethods A 69 year old male presented with profound swelling over the right eye and right side of forehead. On admission the physicians made the diagnosis of septic shock. Patient had no history of alcohol abuse, insect bite, infection, recent penetrating injury, blunt trauma, face surgery or known immunosuppression conditions such as diabetes mellitus. Orbital CT showed a predominantly preseptal soft‐tissue swelling consistent with the diagnosis of periorbital necrotizing fasciitisResults Patient started on empiric treatment with broad‐spectrum intravenous antibiotics that modified according to blood culture results few days later. Surgical debridement and microbiologic evaluation of the necrotic tissue were performed. Streptococcus pyogenes and Staphylococcus aureus were isolated from tissue samples. Patient was further treated with twenty sessions of Hyperbaric Oxygen Therapy. Complete resolution of the infection occurred six weeks after initial diagnosis.Conclusion Treatment of periorbital necrotizing fasciitis with intravenous antibiotics and surgical debridement can be further enhanced with Hyperbaric Oxygen sessions with promising results.