Dr.ROULI SUD

, Dr. SUMEET KHANDUJA, Dr.PALLAVI SHARMA

Abstract

A 52‑year‑old female presented with bilateral painful lid swelling since 2 days. On examination, there was bilateral lid edema with periocular skin necrosis and eschar formation with a wooden consistency (like a thick tree bark) insensitive to tactile and painful stimuli. A clinical diagnosis of periorbital necrotizing fasciitis (PNF) was made and immediate surgical debridement was performed till a plane of vital tissue (identified as petechial hemorrhages and till nociceptive stimuli elicited a positive response) was reached . Evaluation of the debrided tissue showed Klebsiella pneumoniae.Daily wound care and parenteral antibiotics were continued till healthy granulation tissue was observed at 1 month.PNF usually occurs after trauma and in immunocompromised patients. It carries a high risk of mortality. Streptococcus is the most common causative organism .A high index of clinical suspicion and immediate surgical debridement is essential in these cases.