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  • Title: Streptococcal preseptal cellulitis complicated by the toxic Streptococcus syndrome.
    Author: Ingraham HJ, Ryan ME, Burns JT, Shuhart D, Tenedios G, Malone W, Bitterly T, Youn B, Huffard R.
    Journal: Ophthalmology; 1995 Aug; 102(8):1223-6. PubMed ID: 9097751.
    Abstract:
    BACKGROUND: After decades of decline in the incidence of severe infections secondary to group A streptococci, a dramatic increase in the frequency and severity of infections with these organisms has been reported since 1984, including a "toxic Streptococcus syndrome," resembling staphylococcal toxic shock syndrome. To the authors' knowledge, this entity has never been described after ocular infection. METHODS: In a previously healthy 3-year-old boy, preseptal cellulitis developed secondary to minor trauma to the eyelid, progressing rapidly to hypotension, respiratory distress, and an erythrodermic desquamating rash. Ocular and blood cultures grew group A beta-hemolytic streptococci. Appropriate antibiotic coverage and management of systemic manifestations led to rapid improvement, although necrosis developed in the right upper anterior eyelid, requiring skin grafts. RESULTS: More than 3 years since the incident, the patient is free of infection and has a good cosmetic result after skin grafting and revisions for scarring and adhesions. CONCLUSIONS: Streptococcal preseptal cellulitis is not unusual, particularly after trauma. Ophthalmologists must be aware of the re-emergence of more virulent organisms with increased potential for morbidity and mortality.
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