Correspondence

Periorbital necrotizing cellulitis A 49‐year‐old Japanese woman with uncontrolled diabetes and alcohol abuse noticed a slight red discoloration above the right upper eyelid on the day after she had got very drunk. In spite of the treatment with antibiotics given by local physicians, her right upper and lower eyelids gradually became edematous so that she could not open her right eye. She was referred to us 7 days after the onset of the disease. Physical examination revealed marked erythema and swelling on the right eyelid with yellow, partially black necrotic tissues ( Fig. 1). A thick purulent discharge was drained from the right lateral canthus. The eyeground examination was unremarkable, and ocular movements were intact. Computed tomographic scans of the orbits showed neither orbital nor sinus involvement. The peripheral white blood cell count was 11,550/mm 3 . A culture of pus yielded β‐hemolytic, group A, Streptococcus pyogenes. The periorbital edema resolved after surgical debridement and systemic administration of imipenem/cilastatin and cefazolin for 3 weeks; however, facial nerve palsy of the right temporal branches still remains after 2 months ( Fig. 2). 1Marked edema and erythema on the right eyelid2Facial nerve palsy after healing of the wound. Note lack of furrows on right half of forehead