Postoperative infection with group A beta-hemolytic Streptococcus after blepharoplasty.

Objective: To report a case of group A beta-hemolytic streptococcal infection with signs of early necrotizing fasciitis after cosmetic blepharoplasty in a healthy patient.

Methods: Interventional case report. Methods: A healthy 59-year-old woman underwent outpatient bilateral upper and lower blepharoplasty with midface lifting. Thirty hours postoperatively she developed marked pain and edema of the left eyelids and face, and a violaceous eyelid bulla, which heralded early necrotizing fasciitis. Culture of the serosanguinous exudates from the left eyelid revealed group A beta-hemolytic Streptococcus organisms.

Results: The patient was treated with intravenous antibiotics, intravenous corticosteroids, hyperbaric oxygen therapy, and wound debridement. The infection resolved with mild cicatrization of the left upper eyelid.

Conclusions: Group A beta-hemolytic Streptococcus is an increasingly recognized cause of infection that occurs after trauma or surgery, even in highly vascularized areas such as the eyelids and face. It is a potentially devastating infection, particularly in vascularly compromised patients, and requires immediate and aggressive treatment.