A Case of Facial Erysipelas Complicated by Necrotizing Fasciitis

Erysipelas is an acute dermohypodermitis (non-necrotizing) bacterial infection, mainly caused by group A beta-hemolytic streptococcus.Erysipelas is also known as “Saint Anthony’s fire” due to its intense and burning skin rash. The lower limbs are affected in more than 80% of cases, and identified risk factors include disruption of the skin barrier, lymphedema, and obesity.
A 50-year-old Malian woman, married and a housewife, with no notable medical history, consulted for a necrotic and crusted facial erosion that had been evolving for one week following a traumatic wound, leading to a fever of 38.4°C. She reportedly took a non-steroidal anti-inflammatory drug (Diclofenac), which resulted in transient improvement.
On examination, her temperature was 39.6°C, and there was an erythematous swelling measuring 27 x 20 cm in diameter with a well-defined, hot, painful erosive-crusted surface resembling a geographical map, with areas of fibrino-necrotic base located on the face. The upper and lower eyelids were swollen, causing difficulty opening the eyes. The rest of the examination was unremarkable.
A diagnosis of facial erysipelas complicated by necrotizing fasciitis was made. Treatment with amoxicillin plus clavulanic acid and paracetamol was initiated. Local wound care and tetanus antiserum were also administered. While facial involvement is rare, it does occur and should be suspected in any painful facial swelling. It must be a concern for clinicians, as its complication, necrotizing fasciitis, can be fatal.

Keywords: Erysipelas, Face, Complicated, Necrotizing Fasciitis.