STREPTOCOCCAL PRESEPTAL CELLULITIS COMPLICATED BY THE TOXIC STREPTOCOCCUS SYNDROME

Background: After decades of decline in the incidence of severe infect ions secondary to group A streptococci, a dramatic increase in the fre quency and severity of infections with these organisms has been report ed since 1984, including a ''toxic Streptococcus syndrome,'' resemblin g 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 sec ondary to minor trauma to the eyelid, progressing rapidly to hypotensi on, respiratory distress, and an erythrodermic desquamating rash, Ocul ar and blood cultures grew group A beta-hemolytic streptococci. Approp riate antibiotic coverage and management of systemic manifestations le d to rapid improvement, although necrosis developed in the right upper anterior eyelid, requiring skin grafts. Results: More than 3 years si nce the incident, the patient is free of infection and has a good cosm etic result after skin grafting and revisions for scarring and adhesio ns. Conclusions: Streptococcal preseptal cellulitis is not unusual, pa rticularly after trauma. Ophthalmologists must be aware of the re-emer gence of more virulent organisms with increased potential for morbidit y and mortality.