title: Case report of orbital cellulitis and necrotizing fasciitis from melioidosis.
abstract: A 48-year-old Thai male farmer presented with progressive swelling of the right eyelid and high-grade fever. His visual acuity declined and the right side of his forehead developed a necrotic skin lesion with a purulent discharge. CT of the orbits suggested orbital cellulitis with subperiosteal abscess. Intravenous ceftriaxone and clindamycin were given empirically but then switched to vancomycin and meropenem because of rapid deterioration together with clinical sepsis. Burkholderia pseudomallei was isolated from the blood 3 days after the treatment, and the antibiotics were then switched to intravenous ceftazidime. The liver enzymes were elevated, and imaging of the abdomen revealed liver and splenic abscesses. After 14 days, the patient showed marked clinical improvement, became afebrile, and regained his OD visual acuity. A repeat CT of the orbit showed improvement with no subperiosteal abscess. The antibiotic was then switched to oral trimethoprim/sulfamethoxazole in combination with doxycycline for 6 months.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. drpreamjit@gmail.com
authors.forename: Preamjit
authors.initials: P
authors.lastname: Saonanon
authors.forename: Suppapong
authors.initials: S
authors.lastname: Tirakunwichcha
authors.forename: Wirongrong
authors.initials: W
authors.lastname: Chierakul
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D016957:Burkholderia pseudomallei / Q000302:isolation & purification*; D002442:Ceftazidime / Q000627:therapeutic use; D015818:Eye Infections, Bacterial / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D019115:Fasciitis, Necrotizing / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D008875:Middle Aged; D054517:Orbital Cellulitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D002442:Ceftazidime