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.