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A 47-year-old man with a necrotic wound after trauma
Digital Journal of Ophthalmology 2021
Volume 27, Number 2
May 17, 2021
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Donald C. Hubbard II, BS | Texas A&M College of Medicine Jacob W. Fleenor, MD | Baylor Scott and White Eye Institute and Texas A&M College of Medicine Maxwell G. Su, MD | Baylor Scott and White Eye Institute and Texas A&M College of Medicine Jonathan H. Tsai, MD | Baylor Scott and White Eye Institute and Texas A&M College of Medicine
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| Differential Diagnosis | The patient’s clinical history and imaging findings suggested a disease with a fulminant pathology. Given his history of periorbital trauma and rapidly developing necrosis, our differential diagnosis was focused on infectious causes. In this category, we most strongly considered necrotizing fasciitis and orbital cellulitis. Invasive fungal disease was suspected less strongly, because the patient was neither immunocompromised nor diabetic.
Necrotizing fasciitis is a relatively uncommon infection that can present following skin trauma. It can occur in any part of the body, but most cases involve the extremities. Initial signs and symptoms include swelling, fever, pain, and erythema. Diagnosis may be difficult in the early phase of the disease because it mimics other superficial skin infections, such as cellulitis or abscess.
Orbital cellulitis is another infection that may occur as a consequence of trauma. Signs and symptoms include eyelid erythema and swelling, pain with eye movement, ophthalmoplegia, decreased visual acuity, proptosis, and chemosis. The diagnosis is clinical; however, imaging can reveal the degree of orbital involvement.
Invasive fungal disease, in this case specifically mucormycosis, exhibits many of the same signs and symptoms listed above. Mucor is a ubiquitous fungus often found in soil and should be considered in any case of trauma associated with soil that results in an acute eschar resembling necrotizing fasciitis.
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