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Fewer than 50 cases of invasive group A streptococcal (iGAS) eyelid infections have been reported.1 Predisposing factors include skin trauma or surgery2–7 and immunosuppression.3,4 iGAS preseptal cellulitis can be devastating; potentially leading to streptococcal gangrene of the eyelids,1 which can be fatal with a mortality of 40% in the presence of bacteraemia, and an overall mortality of 18%.1
An 80 year old man with rheumatoid arthritis presented with rapidly spreading periorbital erythema involving both eyes within 12 hours, having started at the left pinna which was markedly swollen and discharging (fig 1).
Empirical treatment was begun for possible necrotising streptococcal infection with clindamycin 900 mg four times daily and imipenem 500 mg four …
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