Grand Rounds

An elderly patient with dementia and an otherwise unknown past medical history presented to the emergency room with significant periorbital swelling of unknown duration, found to have tachycardia, leukocytosis, and an elevated CRP. Exam was notable for with ruptured bullae and purulence in the periorbital region and extending to the right cheek. CT Facial demonstrated concern for periorbital and facial cellulitis, and culture of the purulent material was positive for group A streptococcus. Using the Laboratory Risk Indicator to Differentiate Cellulitis from Necrotizing Fasciitis, there was high clinical suspicion for periorbital necrotizing fasciitis. Given the patient’s age, surgical debridement was deferred in favor of conservative medical management. A modified treatment protocol was pursued, most notably incorporating the use of pure dilute hypochlorous acid spray in addition to intravenous antibiotics and other topical wound care. The patient tolerated the treatment well and responded well to therapy. This case underscores the possibility of conservative management for select cases of and the utility of pure dilute hypochlorous acid spray in the treatment of periorbital necrotizing fasciitis.

Presentation Date: 04/16/2026
Issue Date: 04/24/2026