Abstract

Introduction: Necrotizing fasciitis is a rare and serious pathology responsible for rapid massive necrotic destruction of oculo orbito palpebral tissue following infectious vascular thrombosis. The interest of this work is to underline the diagnostic and therapeutic urgency of this exceptional pediatric ophthalmological pathology which rapidly threatens the visual but above all vital prognosis. We report to you the observation of an apparently perfectly healthy infant whose bilateral ocular involvement despite intensive treatment led to blindness. Observation: The infant B.H aged 9 months hospitalized urgently for purplish edema with ulcerations of the four eyelids occluding the two eyes dating back to 3 days previously. In the antecedents, we find the notion of recurrent conjunctivitis treated by many antibiotic eye drops. On examination, extensive ischemic necrosis of the conjunctiva, underlying sclera and cornea, the rest (of the anterior segment and the fundus) is inexplorable. Cytobacteriological samples came back negative. The inflammatory and immunological assessment is inconclusive as is the conjunctival skin biopsy. The pediatric examination is unremarkable. The diagnosis of necrotizing fasciitis is retained in view of the clinical aspect and especially progressive. Treatment consisted of local and general probabilistic antibiotic therapy, autologous serum as well as daily surgical debridement. The evolution has taken place towards very slow healing at the cost of phthyse of the eyeballs and welding of the four eyelids. Discussion & Conclusion: The literature reports few cases of necrotizing fasciitis in children but always emphasizes the dramatic evolution on the ocular and even the vital level. Our case illustrates this picture well, since despite intensive treatment, both medical and surgical, the evolution has taken place towards healing at the cost of bilateral blindness.