Periorbital necrotizing soft tissue infection due to Streptococcus pyogenes with streptococcal toxic shock syndrome: successful early structured multidisciplinary management

Periorbital necrotizing soft tissue infections (NSTIs) are rare but potentially life-threatening, particularly when complicated by streptococcal toxic shock syndrome (STSS). Rapid systemic deterioration can occur, even in previously healthy individuals. We report a case of a 57-year-old woman who developed periorbital NSTI, complicated by STSS, secondary to Streptococcus pyogenes. Emergency eyelid debridement was performed within 24 h of symptom onset, followed by intensive care management and empirical broad-spectrum intravenous antibiotics, which were subsequently adjusted to pathogen-directed therapy. Localized recurrence on hospital day 6 was treated with repeated, limited debridement and adjunctive, low-concentration antiseptic irrigation. The patient recovered from the STSS. Progressive black necrosis did not occur; visual function was preserved, reconstructive surgery was unnecessary, and complete cosmetic recovery was achieved within eight months. This case underscores that STSS may develop rapidly, even in healthy individuals, and highlights the importance of early, structured, and multidisciplinary management.