Periorbital necrotizing fasciitis in a case of lid and conjunctival amyloidosis
Keywords:Necrotizing fasciitis, Amyloidosis, Eyelid, Conjunctiva
Necrotizing fasciitis is a severe, progressive, rapidly spreading infection of the subcutaneous soft tissue and underlying fascia. Periorbital necrotizing fasciitis is rare owing to the excellent blood supply of the area. Ocular amyloidosis is relatively uncommon- that of the eyelid is typically associated with systemic associations whereas amyloidosis of the conjunctiva is often localised with no other associations. Authors report a case of a 40-year-old female with a 4-year history of eyelid and conjunctival amyloidosis who presented with necrotic ulcers and eschars in the upper and lower lid with purulent discharge, conjunctival mass and a dry looking cornea in the left eye. She was a known case of rheumatoid arthritis (RA) on treatment in the last 2 years. The presentation, investigations and management are described.
McAllister P, O'Neill F, Bharadwaj G, O'Regan B, Laverick S. A presentation of facial necrotizing fasciitis with orbital involvement. J Surg Case Rep. 2013;2013(1):33.
Westermark P, Benson MD, Buxbaum JN, Cohen AS, Fangione B, Ikeda SI et al. Amyloid fibril protein nomenclature 2002. Amyloid. 2002;9:197-200.
Casey K, Cudjoe P, Green JM 3rd, Valerio IL. A recent case of periorbital necrotizing fasciitis--presentation to definitive reconstruction within an in-theater combat hospital setting. J Oral Maxillofac Surg. 2014;72(7):1320-24.
Amrith S, Hosdurga Pai V, Ling WW. Periorbital necrotizing fasciitis-a review. Acta Ophthalmol. 2013;91(7):596-603.
Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85(8):1454-60.
Turecki MB, Taljanovic MS, Stubbs AY, Graham AR, Holden DA, Hunter TB, et al. Imaging of musculoskeletal soft tissue infections. Skeletal Radiol. 2010;39(10):957-71.
Lee Hooi L, Hou BAC, Lay Leng S. Group A Streptococcus necrotising fasciitis of the eyelid: a case report of good outcome with medical management. Ophthal Plast Reconstr Surg. 2011;28:13.
Seal DV. Necrotising fasciitis. Curr Opin Infect Dis. 2001;14:127-32.
Aryasit O, Preechawai P, Kayasut K. Clinical presentation, treatment, and prognosis of periocular and orbital amyloidosis in a university-based referral center. Clin Ophthalmol. 2013;7:801-5.
Mora-Horna ER, Rojas-Padilla R, López VG, Guzmán MJ, Ceriotto A, Salcedo G. Ocular adnexal and orbital amyloidosis: a case series and literature review. Int Ophthalmol. 2016;36(2):281-98.
Pepys MB. Amyloidosis. Annu Rev Med. 2006;57:223-41.
Demirci H, Shields CL, Eagle RC, Shields J. Conjunctival amyloidosis: report of six cases and review of the literature. Surv Ophthalmol. 2006;51:419-33.
Fuerst DJ, Tanzer DJ, Smith RE. Rheumatoid diseases. Int Ophthalmol Clin. 1998;38:47-80.