title: Appearances are deceptive...
abstract: A 31-year-old man was referred with sudden onset of a painful periorbital angio-oedema. Assuming a first episode of allergic or acquired angio-oedema, the patient was treated with a plasma-derived C1 esterase inhibitor, tranexamic acid and fresh-frozen plasma, after the initial treatment with corticosteroids and histamine blockers was unsuccessful. As blood cultures grew group A streptococci, the diagnosis of periorbital necrotising fasciitis was made, and treatment was subsequently changed to clindamycin and ceftriaxone. Necrotising fasciitis involving the periorbita is a rare and potentially lethal differential diagnosis of acute angio-oedema, in particular if accompanied by severe pain and/or fever. Knowledge on the appearance of this disorder cannot be overemphasised, as only early recognition and immediate initiation of high-dose penicillin and clindamycin combined with tissue debridement help to decrease the mortality and morbidity.
authors.affiliation: Department of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland. daniel.franzen@usz.ch
authors.forename: Daniel
authors.initials: D
authors.lastname: Franzen
authors.forename: Raphael
authors.initials: R
authors.lastname: Butsch
authors.forename: Karla
authors.initials: K
authors.lastname: Chaloupka
mesh_terms: D000328:Adult; D000799:Angioedema / Q000175:diagnosis*; D003937:Diagnosis, Differential; D019115:Fasciitis, Necrotizing / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009916:Orbital Diseases / Q000175:diagnosis*; D013290:Streptococcal Infections / Q000175:diagnosis*; D013297:Streptococcus pyogenes / Q000302:isolation & purification