Erysipelas, a bacterial skin infection caused by Group A β-hemolytic Streptococci, typically affects the superficial layers of the skin. However, a recent case study highlights an extraordinary presentation of gangrenous-phlegmonous erysipelas leading to necrosis of the upper eyelid, a rare and severe manifestation.
Case Highlights
A 43-year-old patient presented with swelling and pain in the periorbital area, redness on the face, and difficulty opening the right eye. Diagnostic challenges arose due to atypical symptoms, such as the absence of early general intoxication and characteristic skin redness. Laboratory results revealed the presence of Staphylococcus epidermidis and Group A Streptococci in wound cultures, confirming the diagnosis.
Medical and Surgical Management
The patient underwent comprehensive treatment:
- Antibiotic Therapy: Intravenous ceftriaxone and metronidazole to combat infection.
- Surgical Intervention: Drainage of an abscess and removal of necrotic tissue in the upper eyelid area.
- Advanced Wound Care: An A-PRF membrane was used to close the wound, promoting tissue regeneration and preserving eyelid mobility.
The patient's postoperative recovery was uneventful, with complete healing of the eyelid and restoration of its mobility. Follow-up assessments confirmed satisfactory cosmetic and functional outcomes.
Clinical Implications
This case underscores the importance of recognizing atypical presentations of erysipelas. Early and accurate diagnosis, combined with multidisciplinary management, is crucial to prevent complications such as gangrene and tissue necrosis. The use of innovative therapies like A-PRF membranes highlights advancements in wound care and reconstructive surgery.
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