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Presentation type	E-poster
Title	Preseptal cellulitis turning into necrotizing fasciitis: a pediatric emergency

Purpose	Necrotizing fasciitis is a rare but rapidly progressive infection with mortality rates of 20–40%, rising up to 80% when diagnosis is delayed; even facial forms carry a mortality of 12–28%. We report a pediatric case arising from preseptal cellulitis, emphasizing the need for early recognition
Methods	Case report
Results	A 5-year-old girl presented with a 48-hour history of left upper eyelid swelling after minor trauma. Initial examination showed fever (38.3°C), marked periorbital edema, preserved ocular motility, and no signs of orbital involvement. CRP was 10.4 mg/L. Intravenous amoxicillin–clavulanate was started. Within 24 hours, clinical worsening with contralateral extension prompted CT imaging, confirming preseptal cellulitis. At 48 hours, abrupt deterioration occurred: the left upper eyelid, adjacent to the initial wound, became necrotic, while the right eye developed severe edema preventing opening. Necrotizing fasciitis was suspected. Wound and blood cultures were obtained, and CRP rose to 177 mg/L. Broad-spectrum antibiotics (piperacillin–tazobactam, vancomycin, clindamycin) and urgent surgical debridement were initiated immediately, prior to microbiological results. Cultures grew Streptococcus pyogenes, allowing targeted therapy. Adjunctive hyperbaric oxygen therapy was introduced. Clinical outcome was favorable, with regression of edema and limited residual skin defect
Conclusion	This case highlights how an apparently uncomplicated preseptal cellulitis can evolve within hours into necrotizing fasciitis. Given its high mortality, especially when diagnosis is delayed, early suspicion, close reassessment, and immediate multidisciplinary management are critical to improving outcomes
Conflict of interest	No

Authors 1

Last name	LE
Initials	A
Department	CHU St Pierre
City	Bxl

Authors 2

Last name	Walid Benlmostapha
Initials	WB
Department	HSP
City	Bxl

Authors 3

Last name	Rayann Chamas
Initials	RC
Department	HSP
City	Bxl

Authors 4

Last name	Edward Boutremans
Initials	EB
Department	CH St Pierre
City	Bxl