Prompt diagnosis and treatment of peri-orbital necrotising fasciitis caused by group A β-haemolytic Streptococcus (GAS): a case report

Necrotising fasciitis is a devastating infection characterised by rapidly progressing necrotising infection of the superficial fascia with secondary necrosis of the overlying skin.

To describe the pathophysiology, differential diagnosis, and outcome in a rare case of periorbital necrotising fasciitis caused by group A β-haemolytic Streptococcus.

A 60-year-old female with insulin-dependent diabetes presented with pyrexia and bilateral peri-orbital swelling, progressing to left periorbital necrotising fasciitis. It was caused by dual infection with group A β-haemolytic Streptococcus and Herpes Simplex Virus 1.

A combination of intravenous antibiotics and surgical debridement and subsequent skin grafting resulted in a beneficial outcome in our patient.

Differentiating cellulitis and necrotising fasciitis can be difficult when presenting signs and symptoms are non-specific. If not treated quickly with antibiotics and debridement of the infected tissue, the patient may develop septic shock within hours.