title: Streptococcal preseptal cellulitis complicated by the toxic Streptococcus syndrome.
abstract: BACKGROUND
  After decades of decline in the incidence of severe infections secondary to group A streptococci, a dramatic increase in the frequency and severity of infections with these organisms has been reported since 1984, including a "toxic Streptococcus syndrome," resembling staphylococcal toxic shock syndrome. To the authors' knowledge, this entity has never been described after ocular infection.
  
  
  METHODS
  In a previously healthy 3-year-old boy, preseptal cellulitis developed secondary to minor trauma to the eyelid, progressing rapidly to hypotension, respiratory distress, and an erythrodermic desquamating rash. Ocular and blood cultures grew group A beta-hemolytic streptococci. Appropriate antibiotic coverage and management of systemic manifestations led to rapid improvement, although necrosis developed in the right upper anterior eyelid, requiring skin grafts.
  
  
  RESULTS
  More than 3 years since the incident, the patient is free of infection and has a good cosmetic result after skin grafting and revisions for scarring and adhesions.
  
  
  CONCLUSIONS
  Streptococcal preseptal cellulitis is not unusual, particularly after trauma. Ophthalmologists must be aware of the re-emergence of more virulent organisms with increased potential for morbidity and mortality.
authors.affiliation: Department of Ophthalmology, Geisinger Medical Center, Danville, PA 17822-2120, USA.
authors.forename: H J
authors.initials: HJ
authors.lastname: Ingraham
authors.forename: M E
authors.initials: ME
authors.lastname: Ryan
authors.forename: J T
authors.initials: JT
authors.lastname: Burns
authors.forename: D
authors.initials: D
authors.lastname: Shuhart
authors.forename: G
authors.initials: G
authors.lastname: Tenedios
authors.forename: W
authors.initials: W
authors.lastname: Malone
authors.forename: T
authors.initials: T
authors.lastname: Bitterly
authors.forename: B
authors.initials: B
authors.lastname: Youn
authors.forename: R
authors.initials: R
authors.lastname: Huffard
mesh_terms: D000900:Anti-Bacterial Agents; D002481:Cellulitis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000209:etiology* / Q000628:therapy; D005131:Eye Injuries / Q000150:complications / Q000628:therapy; D005143:Eyelids / Q000293:injuries / Q000382:microbiology / Q000473:pathology; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008297:Male; D009336:Necrosis; D009916:Orbital Diseases / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D012131:Respiratory Insufficiency / Q000209:etiology; D012772:Shock, Septic / Q000150:complications* / Q000628:therapy; D016038:Skin Transplantation; D013290:Streptococcal Infections / Q000209:etiology* / Q000628:therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents