title: Orbital compressed air and petroleum injury mimicking necrotizing fasciitis.
abstract: BACKGROUND
  Orbital injury secondary to petroleum-based products is rare. We report the first case, to our knowledge, of a combined compressed air and chemical orbital injury, which mimicked necrotizing fasciitis.
  
  
  METHODS
  A 58-year-old man was repairing his motorcycle engine when a piston inadvertently fired, discharging compressed air and petroleum-based carburetor cleaner into his left eye. He developed surgical emphysema, skin necrosis, and a chemical cellulitis, causing an orbital compartment syndrome. He was treated initially with antibiotics and subsequently with intravenous steroid and orbital decompression surgery. There was almost complete recovery by 4 weeks postsurgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Petroleum-based products can cause severe skin irritation and necrosis. Compressed air injury can cause surgical emphysema. When these two mechanisms of injury are combined, the resulting orbitopathy and skin necrosis can mimic necrotizing fasciitis and cause diagnostic confusion. A favorable outcome is achievable with aggressive timely management.
authors.affiliation: Oxford Eye Hospital, Headington, Oxford, United Kingdom.
authors.forename: Faye E
authors.initials: FE
authors.lastname: Mellington
authors.affiliation: Royal Berkshire NHS Foundation Trust, Reading, United Kingdom.
authors.forename: Annette S
authors.initials: AS
authors.lastname: Bacon
authors.affiliation: Royal Berkshire NHS Foundation Trust, Reading, United Kingdom.
authors.forename: Mohammed A J
authors.initials: MA
authors.lastname: Abu-Bakra
authors.affiliation: Ear, Nose and Throat Department, John Radcliffe Hospital, Headington, Oxford, United Kingdom.
authors.forename: Pablo
authors.initials: P
authors.lastname: Martinez-Devesa
authors.affiliation: Oxford Eye Hospital, Headington, Oxford, United Kingdom.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Norris
mesh_terms: D001753:Blast Injuries / Q000150:complications*; D058868:Compressed Air / Q000009:adverse effects*; D015807:Eye Injuries, Penetrating / Q000209:etiology*; D019115:Fasciitis, Necrotizing / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000293:injuries*; D009916:Orbital Diseases / Q000139:chemically induced*; D010578:Petroleum / Q000009:adverse effects*; D013352:Subcutaneous Emphysema / Q000209:etiology*
chemical_list: D010578:Petroleum
keywords: air; cellulitis; chemical; compressed; fasciitis; injury; necrotizing; orbit; petroleum