A 69-year-old woman presented with fever and swelling of the left eyelid (a) for five days. She had undergone esthetic upper and lower blepharoplasty. On initial examination, a grey-tan discoloration and swelling were observed on the left eyelid. Her body temperature was 39.2°C, HbA1c was 6.3%, and laboratory risk indicator necrotizing fasciitis (LRINEC) score was 2. CT scan image has been provided (b). The patient was admitted and given 2 g/day of flomoxef sodium intravenously.

Five hours later, she developed abdominal pain and cold sweats. Her BP dropped (Systole dropped from 120 to 50 mmHg). Necrosis of the eyelid was noted (c), and LRINEC score increased from 2 to 8. Emergency debridement was done (d), and histopathology images were provided (e). Streptococcus pyogenes  infection was detected from her blood culture and eye swab. After treatment with oral levofloxacin, eyelid…