A Rare Case of Periorbital Necrotizing Fasciitis associated with Mortality following Herpes Zoster Ophthalmicus – A Case Report

A Rare Case of Periorbital Necrotizing Fasciitis

Abstract

Introduction: Necrotizing fasciitis following cutaneous herpes zoster is rare. Among three reported cases worldwide, one involved the head region. None had fatalities.
Case report: We report a seventy year-old Malay gentleman who presented with left painful periorbital swelling for six days, preceded by vesicular rashes. There were associated necrotic patches involving both upper and lower eyelids with foci of purulent discharge from the medial and lateral canthus. He was treated empirically with intravenous ceftriaxone, oral and topical acyclovir. Skin swab cultures yielded group B streptococcus and S.aureus, both sensitive to penicillin. Antibiotics were switched to cloxacillin and metronidazole, followed by bedside debridement of the eyelids. Despite clinical improvement, supported by normalization of biochemical markers, he succumbed to sepsis related complications.
Conclusion: Periorbital necrotizing fasciitis can be fatal. This represents the first reported mortality associated with periorbital necrotizing fasciitis secondary to cutaneous herpes zoster. Additional similar case reports would be invaluable to guide future management of this rare entity.