Orbital streptococcal gangrene and AIDS.

Streptococcal gangrene can present to the ophthalmologist as a fulminant orbital cellulitis involving the eyelids, globe and orbit. Compromised vision is likely, as well as serious systemic illness and death. It commonly affects young and healthy hosts and, prior to this presentation, has never been reported in a patient with HIV infection. We studied a case of streptococcal gangrene of the eyelids and orbit in a patient with AIDS. The infection was treated with debridement and intravenous antibiotics, and showed eventual improvement with the exception of visual function. A biopsy of the lesion exhibited extensive soft tissue necrosis with a predilection for blood vessels, resulting in thrombosis and infarction. Cultures grew out heavy group A beta-hemolytic Streptococcus. This case illustrates that streptococcal gangrene can occur with HIV, although to date this combination has been rare. Early diagnosis is crucial and includes recognition of incipient cutaneous, histopathological and anterior segment ischemia signs.