Periorbital necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus periorbital necrotizing fasciitis.

PURPOSE: To report a case of a patient with periorbital necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus (MRSA).

METHODS

Case report. A previously healthy 33-year-old man was presented with pain and rapidly progressive swelling of the right upper eyelid following a minor trauma. Computed tomography scanning revealed soft tissue swelling and fracture of the anterior wall of the right frontal sinus. Oral amoxicillin + klavulanat 1 g, twice daily was started. Over the next 24 hours periorbital necrotizing fasciitis was developed. A wound swab was taken and sent for microscopic evaluation, culture, and antibiotic sensitivity. The patient was started on intravenous crystallized penicillin, third-generation cephalosporin, and metronidazol treatment. An urgent extensive necrotic tissue debridement and frontal sinus curettage were performed.

RESULTS

Wound culture yielded MRSA which showed sensitivity to the given antibiotics. The patient responded to the treatment which was continued for 14 days.

CONCLUSIONS

Monomicrobial MRSA should be considered in the etiology of periorbital necrotizing fasciitis. Early diagnosis and prompt surgical and medical therapy are essential in the management of periorbital necrotizing fasciitis.