Short communication
Periorbital necrotising fasciitis secondary to scratching
Fascitis necrosante periorbitaria secundaria a rascado
Read
4
Timeswas read the article
3
Total PDF
1
Total HTML
Share statistics
array:24 [ "pii" => "S2173579419300404" "issn" => "21735794" "doi" => "10.1016/j.oftale.2019.01.006" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1468" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:242-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669119300346" "issn" => "03656691" "doi" => "10.1016/j.oftal.2019.01.005" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1468" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:242-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 39 "formatos" => array:2 [ "HTML" => 31 "PDF" => 8 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comunicación corta</span>" "titulo" => "Fascitis necrosante periorbitaria secundaria a rascado" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "242" "paginaFinal" => "247" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Periorbital necrotising fasciitis secondary to scratching" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1114 "Ancho" => 1305 "Tamanyo" => 231925 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Fotocomposición: A. Corte axial de TC a nivel del párpado superior donde se observa edematización de tejidos blandos periorbitarios de predominio preseptal. B. Corte axial de TC al nivel de párpado inferior que demuestra edematización de tejidos bandos periorbitarios a nivel preseptal. C. Corte coronal de TC que muestra edematización de tejidos blandos periorbitarios en canto externo y mejilla derecha. D. Fotografía de párpados del ojo derecho mostrando placas de necrosis fibrinoide en ambos párpados. E. Aspecto tras desbridamiento quirúrgico de las zonas de necrosis fibrinoide y mechado con tul de betadine. (Los autores cuentan con el consentimiento informado de la paciente para la publicación de las imágenes que ilustran este artículo.)</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I.A. Placinta, E. España-Gregori, A. Rodrigo-Hernández, C. Martínez-Rubio, J. Safont-Albert, M.Á. Bort-Martí" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I.A." "apellidos" => "Placinta" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "España-Gregori" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Rodrigo-Hernández" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Martínez-Rubio" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Safont-Albert" ] 5 => array:2 [ "nombre" => "M.Á." "apellidos" => "Bort-Martí" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579419300404" "doi" => "10.1016/j.oftale.2019.01.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419300404?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669119300346?idApp=UINPBA00004N" "url" => "/03656691/0000009400000005/v2_202201280719/S0365669119300346/v2_202201280719/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579419300349" "issn" => "21735794" "doi" => "10.1016/j.oftale.2018.12.008" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1454" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:248-51" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Adult orbital xanthogranuloma as a cause of recurrent palpebral swelling" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "248" "paginaFinal" => "251" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Xantogranuloma orbitario del adulto como causa de inflamación palpebral recidivante" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1070 "Ancho" => 950 "Tamanyo" => 73026 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography showing preseptal infiltration in the right eye (arrow). (A) Axial projection. (B) Lateral projection.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Navarro-Hernández, A. Hernández-Pons, S. Montolío-Marzo, M. Pérez-López" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Navarro-Hernández" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Hernández-Pons" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Montolío-Marzo" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Pérez-López" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669119300206" "doi" => "10.1016/j.oftal.2018.12.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669119300206?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419300349?idApp=UINPBA00004N" "url" => "/21735794/0000009400000005/v1_201904290704/S2173579419300349/v1_201904290704/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579419300350" "issn" => "21735794" "doi" => "10.1016/j.oftale.2018.12.009" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "1456" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:237-41" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Invasive aspergillosis manifesting as retinal necrosis in a patient treated with ruxolitinib" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "237" "paginaFinal" => "241" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Necrosis retiniana como manifestación de aspergilosis invasiva en un paciente tratado con ruxolitinib" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1383 "Ancho" => 1255 "Tamanyo" => 151963 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retinal compromise on day 11.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Moruno-Rodríguez, J.L. Sánchez-Vicente, T. Rueda-Rueda, B. Lechón-Caballero, A. Muñoz-Morales, F. López-Herrero" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Moruno-Rodríguez" ] 1 => array:2 [ "nombre" => "J.L." "apellidos" => "Sánchez-Vicente" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Rueda-Rueda" ] 3 => array:2 [ "nombre" => "B." "apellidos" => "Lechón-Caballero" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Muñoz-Morales" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "López-Herrero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S036566911930022X" "doi" => "10.1016/j.oftal.2018.12.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036566911930022X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419300350?idApp=UINPBA00004N" "url" => "/21735794/0000009400000005/v1_201904290704/S2173579419300350/v1_201904290704/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Periorbital necrotising fasciitis secondary to scratching" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "242" "paginaFinal" => "247" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I.A. Placinta, E. España-Gregori, A. Rodrigo-Hernández, C. Martínez-Rubio, J. Safont-Albert, M.Á. Bort-Martí" "autores" => array:6 [ 0 => array:4 [ "nombre" => "I.A." "apellidos" => "Placinta" "email" => array:1 [ 0 => "iaplacinta@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "España-Gregori" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Rodrigo-Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Martínez-Rubio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Safont-Albert" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "M.Á." "apellidos" => "Bort-Martí" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026 Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Plástica, Estética y Reparadora, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026 Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fascitis necrosante periorbitaria secundaria a rascado" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1114 "Ancho" => 1305 "Tamanyo" => 232224 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Photocomposition: (A) axial CT section at the upper eyelid level showing edematization of predominantly preseptal periorbital soft tissues. (B) Axial CT section at the lower eyelid level showing periorbital tissues edema at the preseptal level. (C) CT coronal section showing edematization of periorbital soft tissues in the external canthus and right cheek. (D) Right eye eyelid photography showing fibrinoid necrosis plaques in both eyelids. (E) Appearance after surgical debridement of areas of fibrinoid necrosis and betadine net lining. (The authors have the informed consent of the patient for publishing the images that illustrate this article.).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Necrotising fasciitis (NF) is asevere, rapidly progressing infection of the skin, subcutaneous cellular tissue and superficial fascia.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> It affects primarily the abdominal wall, perineal area and lower limbs,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> associating a high mortality of 30–70% according to different series.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> The subcutaneous cellular tissue necrosis is due to thrombosis caused by intense perivascular inflammation. Compromise of subcutaneous cellular tissue is usually greater than that observed by changes in the overlying skin.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Facial and orbital involvement is very rare due to the rich vascularization of these areas.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Periorbital necrotising fasciitis (PNF) is a rare form of NF, with an estimated incidence of 0.24/million/year,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> whereas the incidence of NF in other parts of the body is 4–10<span class="elsevierStyleHsp" style=""></span>cases/million/year.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> PNF is classified into 2 types according to the causative agent: type I, polymicrobial infection produced by anaerobes, gram-negative bacilli and enterococci, mainly affecting immunocompromised patients; and type II produced by group A <span class="elsevierStyleItalic">Streptococcus pyogenes</span> with or without <span class="elsevierStyleItalic">Staphylococcus aureus</span> coinfection compromising immunocompetent patients.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> PNF type I is associated to a mortality rate of 20%, whereas in PNF type II mortality is 30–35%,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> attributed mainly to streptococcal toxic shock syndrome (STSS).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Recently, in the largest literature review of 104 cases of PNF, Lazzeri et al.,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> described an overall mortality of 14.42%, while Rajak et al.,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> in a series of 29 cases from 3 Australian and 2 United Kingdom centers, reported a global mortality of 3%. The loss of skin and subcutaneous cellular tissue, with ensuing cosmetic and functional repercussions, represents the main morbidity associated to PNF; the postseptal dissemination of the infection, although very rare, can cause arterial occlusion and residual blindness.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinic case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">Female, 80, without ophthalmological records, hypertension being the only systemic antecedent, seeking consultation due to worsening of her right angioedema secondary to insect sting, diagnosed the day prior and treated with gentamicin/dexamethasone eye drops 3 times a day. The patient reported itching and intense right periorbital pain.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the examination, blepharospasm was observed in the right eye, with the impossibility of spontaneous palpebral opening, erythema and indurated edema in the upper and lower right eyelids, with areas of laceration due to scratching and skin suppuration. The patient expressed general discomfort. Blood pressure was 110/45<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg, heart rate 102<span class="elsevierStyleHsp" style=""></span>beats/min and axillary temperature 37.1<span class="elsevierStyleHsp" style=""></span>°C.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Blood work was requested, observing 15,730<span class="elsevierStyleHsp" style=""></span>leukocytes/μl (3500–10,500), of which 95.2% were neutrophils. Glomerular filtration rate of 22<span class="elsevierStyleHsp" style=""></span>ml/min (90–130<span class="elsevierStyleHsp" style=""></span>ml/min), creatinine level of 2.11<span class="elsevierStyleHsp" style=""></span>mg/dl (0.51–0.95<span class="elsevierStyleHsp" style=""></span>mg/dl), urea 112<span class="elsevierStyleHsp" style=""></span>mg/dl (10–50<span class="elsevierStyleHsp" style=""></span>mg/dl) and a C-reactive protein (CRP) of 201<span class="elsevierStyleHsp" style=""></span>mg/l stand out.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Computed tomography (CT) of the orbits without contrast was performed, due to low glomerular filtration, in which poorly defined edematization of the extraconal fat was observed in the upper slope of the right orbit, without liquid collections or freegas, where postseptal affectation cannot be ruled out (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A–C)</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Palpebral laceration and supuration samples were taken for culture, Gram staining and antibiogram.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was diagnosed with orbital cellulitis and admitted for intravenous treatment with meropenem 500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h and linezolid 600<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0040" class="elsevierStylePara elsevierViewall">On the second day of admission, the patient presented 2 large areas of fibrinoid necrosis in the right eye upper and lower eyelids (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D), beside diffuse erythematous rash in the submandibular region, neck and neckline, with a small scaly area at the neckline of approximately 1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>. Microbiology reported the growth of multi-sensitive <span class="elsevierStyleItalic">S. pyogenes</span> and <span class="elsevierStyleItalic">S. aureus</span> resistant to penicillin, but multi-sensitive to other antibiotics.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In view of the new findings and the torpid evolution, PNF was suspected and urgent surgical debridement of fibrinoid necrosis areas of the right upper and lower eyelid was performed until viable tissue was reached (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E). Necrosis affected the skin, the subcutaneous cellular tissue and in certain areas the orbicular muscle fibers. After surgical debridement, a 10% betadine net is left and the area is covered with clean dressings. Likewise, intravenous antibiotic therapy was adjusted to ceftriaxone 1<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h, maintaining linezolid 600<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0050" class="elsevierStylePara elsevierViewall">On the third day of admission, upon uncovering, granulation tissue was observed, fibrin was cleaned with a surgical scrub brush impregnated with chlorhexidine, debridement of necrotic remains was performed and cured with triple-ointment net (mupirocin, sulfadiazine and miconazole). The glomerular filtration rate improved, reaching 52<span class="elsevierStyleHsp" style=""></span>ml/dl and the CRP decreased to 150<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>/l.</p><p id="par0055" class="elsevierStylePara elsevierViewall">On the fourth day, when uncovering to carry out the cure, abundant fibrin and some necrotic remains were debrided as in the previous day (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B), and then occluded with triple-ointment net. Glomerular filtration rate was 70<span class="elsevierStyleHsp" style=""></span>ml/dl and CRP decreased to 60<span class="elsevierStyleHsp" style=""></span>mg/l. Likewise, submandibular and neckline erythema had practically disappeared, leaving only a scaly vestige at the neckline level.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The usual daily cures continued; on the tenth day, when performing the cure and debriding granulation tissue, a loss of substance was observed in the upper eyelid posterior lamella, the defect reaching the conjunctiva (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). Glomerular filtration rate remained at 70<span class="elsevierStyleHsp" style=""></span>ml/dl and CRP continued decreasing to 6.9<span class="elsevierStyleHsp" style=""></span>mg/l, which led to the de-escalation of antibiotic treatment: ceftriaxone 1<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h was maintained and intravenous linezolid was replaced by oral levofloxacin 500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0065" class="elsevierStylePara elsevierViewall">On day 12, when performing the cures and debridement of fibrin, the compromised area of the upper eyelid was connected to that of the lower eyelid below a healthy tissue bridge in the right cheek area (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D).</p><p id="par0070" class="elsevierStylePara elsevierViewall">During the cures on days 13 and 14 no new necrotic areas were observed, the lesions remained stable and with less fibrin. The glomerular filtrate rate was stabilized in 73<span class="elsevierStyleHsp" style=""></span>mg/dl and CRP continued to decrease to the normal range (2.8<span class="elsevierStyleHsp" style=""></span>mg/l).</p><p id="par0075" class="elsevierStylePara elsevierViewall">On day 15 the substance defect was covered by lateral malar flap advance in the lower eyelid, by fixation with nonabsorbable polypropylene monofilament (Prolene<span class="elsevierStyleSup">®</span>, Ethicon) 4.0 to the lateral edge and polyglactin absorbable multifilament 90/10 (Novosyn<span class="elsevierStyleSup">®</span>, B Braun) 4.0 for skin. The upper eyelid defect was corrected by full thickness skin autograft from the right preauricular area. The donor zone was closed by polygluconate absorbable monofilament (Maxon™, Medtronic Covidien Products) 4.0. The graft was fixed with polyglactin absorbable multifilament (Vicryl<span class="elsevierStyleSup">®</span>, Ethicon) 4.0, a silk 3.0 tie and tulle tube.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The postoperative course progressed favorably (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A) and on day 17 the patient was discharged with levofloxacin 500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h, cefditoren 200<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h and erythromycin ointment every 8<span class="elsevierStyleHsp" style=""></span>h at the bottom of the conjunctival sac for 7 more days. The silk tie and the skin stitches were removed after 7 days. Lubricating gels were indicated during the day and before going to sleep due to incomplete palpebral closure, but with a positive Bell sign.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">At 6 months the right eye palpebral opening and closure were practically complete and cicatrization was correct (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B and C). The right eye visual acuity was not affected at any time. Likewise, the eye fundus remained without notable pathological findings.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">Differential PNF diagnostics include palpebral angioedema, preseptal and orbital cellulitis, diagnoses that our patient received before being correctly diagnosed with PNF. The strong pain, rapid progression, cyanosis, crepitation and the appearance of vesicles filled with fluid that break to give rise to laceration areas are signs that differentiate the pre- and postseptal cellulitis from the true PNF.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> This distinction is essential, since the PNF diagnosis implies the urgent need for surgical debridement of the necrotic tissue paired with empirical intravenous antibiotic therapy.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3,7–9</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">PNF mainly affects adults with a slight male predominance (54–69%).<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a> The present patient did not exhibit associated comorbidities, and half of the patients affected by PNF are usually healthy.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,7</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The causal agent in 50% of cases is <span class="elsevierStyleItalic">S. pyogenes</span>,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,7,8</span></a> on its own or accompanied by <span class="elsevierStyleItalic">S. aureus</span> (18%).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">As initial antibiotic therapy, taking into account that <span class="elsevierStyleItalic">S. pyogenes</span> is the most frequently involved bacteria, a ß-lactam antibiotic such as penicillin or a cephalosporin associated with clindamycin<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a>/linezolid<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> is recommended, or metronidazole if anaerobes are suspected.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> When bound to the ribosomal 50 S unit, clindamycin and linezolid inhibit protein synthesis and therefore the synthesis of pyrogenic exotoxins (M protein, Spe A and B) responsible for STSS.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,7</span></a> STSS diagnosis is performed on the bases of the presence of hypotension, and the involvement of 2 organic systems: renal failure defined as creatinine ≥2<span class="elsevierStyleHsp" style=""></span>mg/dl, platelet count ≤100,000/μl or disseminated intravascular coagulation, transaminase or bilirubin elevation exceeding twice the normal value, acute respiratory distress syndrome, erythematous-desquamative rash or soft tissue necrosis.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Our patient presented hypotension, acute renal failure and erythematous-desquamative rash, which is why STSS was presented and it occurred in 21–31% of cases.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,8</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Cures with negative pressure, hyperbaric oxygen therapy, heparinization and intravenous use of gamma-globulins to neutralize the effect of pyrogenic toxins have been used as adjuvant treatment to surgical debridement and intravenous antibiotic therapy, but their use is controversial.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,7,8</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Patient management was multidisciplinary between Ophthalmology, Plastic surgery, Nephrology and the Infectious Diseases Unit.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The diagnosis presented a CRP of 201<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>/l and 15,730<span class="elsevierStyleHsp" style=""></span>leukocytes/μl, slightly lower than those described by Rajak et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> (mean CRP: 258<span class="elsevierStyleHsp" style=""></span>mg<span class="elsevierStyleHsp" style=""></span>/l and 19,300<span class="elsevierStyleHsp" style=""></span>leukocytes/μl). Even so, in a series of 94 cases Amrith et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> found no association between the leukocyte count at diagnosis and the probability of death; they only found that facial extension and visual involvement in PNF increased the risk of fatal outcome. The present patient presented slight malar involvement, but her vision remained stable throughout the hospital stay. Likewise, age over 50 years has been postulated as a risk factor for a fatal outcome.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In the present case the diagnosis was clinical, but in cases in doubt, CT or MRI can identify suprafascial edema many hours before the appearance of cutaneous signs.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The patient remained in the hospital for 17 days, and in this period she underwent an initial debridement, followed by 5 supplementary debridements. In the series by Rajak et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> the average hospitalization was 16 days and the patients received from 1 to 5 debridements. It is worthy to mention that 5 patients (17%) controlled only with antibiotic therapy without debridement were described.</p><p id="par0135" class="elsevierStylePara elsevierViewall">After debridement, 41% of patients required palpebral reconstructive surgery.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> There is no consensus about the reconstructive technique of choice. For repairing the defects of the upper eyelid anterior lamella, partial or full-thickness skin grafts from the contralateral upper eyelid, retroauricular region, forearm or the forehead have been used.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,7,8</span></a> For our patient it was decided, in collaboration with plastic surgery, to use preauricular skin for the upper eyelid and malar advance flap for the lower eyelid.</p><p id="par0140" class="elsevierStylePara elsevierViewall">The infection seems to have been triggered by the insect bite, causing a clinic of edema and palpebral itching that caused intense scratching by the patient, who had long and unkempt nails. Although the insect bite has been described as the PNF cause,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,7</span></a> the fact that the infection started in both eyelids at the same time makes us think that the abrasions produced by scratching have constituted the necessary rupture for the skin's saprophytic flora (<span class="elsevierStyleItalic">S. pyogenes</span> and <span class="elsevierStyleItalic">S. aureus</span>) or the nails gaining access to the subepidermal level and initiating PNF. The entry path mediated by abrasions, lacerations and penetrating wounds is well known as the most frequently responsible for PNF in up to 64% of cases.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,7,8</span></a> Even so, in up to one third of PNF cases there is no clear infection triggering agent.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0145" class="elsevierStylePara elsevierViewall">PNF is a devastating infection with high associated morbidity and mortality. Early diagnosis, immediate surgical debridement and early empirical antibiotic therapy,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3,7–9</span></a> in a coordinated multidisciplinary management context, are crucial for the successful treatment of this rare entity.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1184810" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1104920" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1184811" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1104921" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-08-27" "fechaAceptado" => "2019-01-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1104920" "palabras" => array:6 [ 0 => "Periorbital necrotising fasciitis" 1 => "<span class="elsevierStyleItalic">Streptococcus pyogenes</span>" 2 => "Streptococcal toxic shock syndrome" 3 => "Scratching" 4 => "Insect bite" 5 => "Linezolid" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1104921" "palabras" => array:6 [ 0 => "Fascitis necrosante periorbitaria" 1 => "<span class="elsevierStyleItalic">Streptococcus pyogenes</span>" 2 => "Síndrome de shock tóxico estreptocócico" 3 => "Rascado" 4 => "Picadura de insecto" 5 => "Linezolid" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">An 80 year-old woman with no relevant medical history, consulted for worsening of right palpebral itching and pain after an insect bite. Her eyelids had areas of laceration due to scratching, which rapidly progressed to fibrinoid necrosis over the first 24<span class="elsevierStyleHsp" style=""></span>h. Lesions were cultivated, revealing <span class="elsevierStyleItalic">Streptococcus pyogenes</span> and <span class="elsevierStyleItalic">Staphylococcus aureus</span>. The patient was admitted to hospital with the diagnosis of periorbital necrotising fasciitis, in order to receive treatment with intravenous ceftriaxone, linezolid, and immediate surgical debridement. She remained in hospital for 17 days. Daily wound management consisted of debridement of necrotic remains, disinfection with chlorhexidine, and wound dressing with mupirocin, sulfadiazine, and miconazole ointments. The patient suffered streptococcal toxic shock syndrome, but she recovered over the first week. Palpebral reconstruction was performed on day 15, consisting of a preauricular total thickness skin graft for the superior eyelid, and lateral malar advancement to cover the lower eyelid. Adequate cosmetic and functional results were obtained.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Mujer de 80 años sin antecedentes médicos que consulta por empeoramiento de picor y dolor palpebral derecho tras la picadura de un insecto. Presenta zonas de laceración por rascado en los párpados, que evolucionan a placas de necrosis fibrinoide durante las primeras 24<span class="elsevierStyleHsp" style=""></span>horas. Se cultivan las lesiones, demostrando <span class="elsevierStyleItalic">Streptococcus pyogenes</span> y <span class="elsevierStyleItalic">Staphylococcus aureus</span>. Se ingresa a la paciente con diagnóstico de fascitis necrosante periorbitaria para tratamiento intravenoso con ceftriaxona, linezolid y desbridamiento quirúrgico urgente. Permanece ingresada durante 17 días; se le realizan curas diarias consistentes en desbridamiento de restos necróticos, limpieza con clorhexidina y curas con pomadas de mupirocina, sulfadiazina y miconazol. Sufre síndrome de shock tóxico estreptocócico, del que se recupera durante la primera semana de ingreso. A las 2 semanas se le realiza reconstrucción plapebral con autoinjerto de piel de espesor total preauricular en el párpado superior y avance malar lateral en el párpado inferior, con adecuado resultado cosmético y funcional.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Placinta IA, España-Gregori E, Rodrigo-Hernández A, Martínez-Rubio C, Safont-Albert J, Bort-Martí MÁ. Fascitis necrosante periorbitaria secundaria a rascado. Arch Soc Esp Oftalmol. 2019;94:242–247.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1114 "Ancho" => 1305 "Tamanyo" => 232224 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Photocomposition: (A) axial CT section at the upper eyelid level showing edematization of predominantly preseptal periorbital soft tissues. (B) Axial CT section at the lower eyelid level showing periorbital tissues edema at the preseptal level. (C) CT coronal section showing edematization of periorbital soft tissues in the external canthus and right cheek. (D) Right eye eyelid photography showing fibrinoid necrosis plaques in both eyelids. (E) Appearance after surgical debridement of areas of fibrinoid necrosis and betadine net lining. (The authors have the informed consent of the patient for publishing the images that illustrate this article.).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1086 "Ancho" => 1305 "Tamanyo" => 227453 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Photocomposition: (A) Right eye eyelid photograph after removing the dressing on day 4. Note the large amount of pus. (B) After chlorhexidine sponge debriding, abundant granulation tissue is observed. (C) Appearance on day 10 after usual debridement, observing highly vitalized tissues without hardly any granulation tissue; the arrow points to an area of connection with the conjunctiva. (D) On day 12, there is an upper eyelid affected area connection with that of the lower eyelid below a healthy skin bridge of the cheek.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1052 "Ancho" => 1305 "Tamanyo" => 134086 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Photocomposition: (A) right eye eyelid photograph on day 17. 2 days after reconstruction, a full-thickness skin graft with a vascular appearance is observed in the upper eyelid. In the lower eyelid, skin coverage was performed advancing the cheek's skin. (B) Appearance 6 months after the reconstruction observing correct opening; the palpebral closure is practically complete (C).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sterptococcal infections of skin and soft tissues" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.L. Bisno" 1 => "D.L. Stevens" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "1996" "volumen" => "334" "paginaInicial" => "240" "paginaFinal" => "245" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Periorbital necrotising fasciitis – a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Amrith" 1 => "V. Hosdurga Pai" 2 => "W.W. Ling" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1755-3768.2012.02420.x" "Revista" => array:6 [ "tituloSerie" => "Acta Ophthalmol" "fecha" => "2013" "volumen" => "91" "paginaInicial" => "596" "paginaFinal" => "603" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22520175" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Periocular necrotising fasciitis with visual loss. Pathogenesis and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V.M. Elner" 1 => "H. Demirichi" 2 => "J.A. Nerad" 3 => "A.S. Hassan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2006.06.037" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2006" "volumen" => "113" "paginaInicial" => "2338" "paginaFinal" => "2345" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16996594" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Disease Society of America" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.L. Stevenes" 1 => "A.L. Bisno" 2 => "H.F. Chambers" 3 => "E.P. Dellinger" 4 => "E.J. Goldstein" 5 => "S.L. Gorbach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/ciu444" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2014" "volumen" => "59" "paginaInicial" => "e10" "paginaFinal" => "e52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24973422" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of periorbital necrotising fasciitis in the UK population: a BOSU study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P.W. Flavahan" 1 => "P. Cauchi" 2 => "M.E. Gregory" 3 => "B. Foot" 4 => "S.R. Drummond" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjophthalmol-2013-304735" "Revista" => array:6 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2014" "volumen" => "98" "paginaInicial" => "1177" "paginaFinal" => "1180" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25136080" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Necrotising fasciitis: an urgent diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Paz Maya" 1 => "D. Dualde Beltrán" 2 => "P. Lemercier" 3 => "C. Leiva-Salinas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Skelet Radiol" "fecha" => "2014" "volumen" => "43" "paginaInicial" => "577" "paginaFinal" => "589" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Periorbital necrotising fasciitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Lazzeri" 1 => "S. Lazzeri" 2 => "M. Figus" 3 => "C. Tascini" 4 => "G. Bocci" 5 => "L. Colizzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjo.2009.167486" "Revista" => array:6 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2010" "volumen" => "94" "paginaInicial" => "1577" "paginaFinal" => "1585" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19897473" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Periocular necrotising fasciitis: a multicenter case series" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.N. Rajak" 1 => "E.C. Figueira" 2 => "A.S. Haridas" 3 => "K. Satchi" 4 => "J.M. Uddin" 5 => "A.A. McNAb" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2016" "volumen" => "100" "paginaInicial" => "1517" "paginaFinal" => "1520" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Necrotising fasciitis: clinical presentation, microbiology, and determinants of mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.H. Wong" 1 => "H.C. Chang" 2 => "S. Pasupathy" 3 => "L.W. Khin" 4 => "J.L. Tan" 5 => "C.O. Low" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2003" "volumen" => "85" "paginaInicial" => "1454" "paginaFinal" => "1460" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful treatment of necrotising fasciitis and streptococcal toxic shock syndrome with the addition of linezolid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Rac" 1 => "K.D. Bojikian" 2 => "J. Lucar" 3 => "K.E. Barber" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Case Rep Infect Dis" "fecha" => "2017" "volumen" => "2017" "paginaInicial" => "5720708" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009400000005/v1_201904290704/S2173579419300404/v1_201904290704/en/main.assets" "Apartado" => array:4 [ "identificador" => "5812" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short communications" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009400000005/v1_201904290704/S2173579419300404/v1_201904290704/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419300404?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 2 | 3 |
| 2020 September | 0 | 1 | 1 |
