title: Postoperative infection with group A beta-hemolytic Streptococcus after blepharoplasty.
abstract: OBJECTIVE
  To report a case of group A beta-hemolytic streptococcal infection with signs of early necrotizing fasciitis after cosmetic blepharoplasty in a healthy patient.
  
  
  METHODS
  Interventional case report.
  
  
  METHODS
  A healthy 59-year-old woman underwent outpatient bilateral upper and lower blepharoplasty with midface lifting. Thirty hours postoperatively she developed marked pain and edema of the left eyelids and face, and a violaceous eyelid bulla, which heralded early necrotizing fasciitis. Culture of the serosanguinous exudates from the left eyelid revealed group A beta-hemolytic Streptococcus organisms.
  
  
  RESULTS
  The patient was treated with intravenous antibiotics, intravenous corticosteroids, hyperbaric oxygen therapy, and wound debridement. The infection resolved with mild cicatrization of the left upper eyelid.
  
  
  CONCLUSIONS
  Group A beta-hemolytic Streptococcus is an increasingly recognized cause of infection that occurs after trauma or surgery, even in highly vascularized areas such as the eyelids and face. It is a potentially devastating infection, particularly in vascularly compromised patients, and requires immediate and aggressive treatment.
authors.affiliation: Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, School of Medicine, Los Angeles, California 90095-7000, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Goldberg
authors.forename: Tina G
authors.initials: TG
authors.lastname: Li
mesh_terms: D019882:Blepharoplasty / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003646:Debridement; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000382:microbiology* / Q000628:therapy; D005141:Eyelid Diseases / Q000382:microbiology* / Q000628:therapy; D019115:Fasciitis, Necrotizing / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D011183:Postoperative Complications / Q000382:microbiology / Q000628:therapy; D015361:Rhytidoplasty; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D000078142:Tazobactam
chemical_list: D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin