You are correct. Initial CT showed orbital and periorbital cellulitis, and repeat CT after worsening showed new preseptal gas formation in keeping w/ necrotizing fasciitis. Periorbital necrotizing fasciitis is extremely rare; it often occurs in non-immunocompromised individuals w/o any hx of trauma who can remain systemically well. Misdiagnosis is common and clinicians should maintain a high level of suspicion, as prompt surgical debridement reduces morbidity and mortality. This pt was taken urgently to the OR, where necrotic skin, orbicularis oculi, and adipose tissue were debrided, w/ preservation of the tarsal margin. He had a good post-op recovery and the wound granulated well.

BMJ Case Reports 2018; doi:10.1136/bcr-2018-224436

You are correct. Erythema ab igne is characterized by reticulated erythema, hyperpigmentation and hypopigmentation, and telangiectasia resulting from chronic exposure to heat, which causes epidermal damage, vasodilation, and hemosiderin deposition. Skin atrophy and blisters or erosions can develop. Tx of erythema ab igne is cessation of heat exposure; mild cases usually self-resolve over several months.

BMJ 2018;361:k1322

You are correct. Bacterial cx of skin swab of the area confirmed group A beta-hemolytic strep. This strep infxn is an underrecognized cause of intertrigo. It usually manifests as a well-demarcated, bright red erythema and maceration of the skin folds, w/ a distinct foul odor and absence of satellite lesions. The infxn can induce formation of psoriasiform guttate skin lesions (scaly erythematous islands), which may resemble satellite lesions. The child may also present w/ low-grade fever and irritability. These features can help distinguish it from candidal dermatitis. This child’s eruption resolved w/ flucloxacillin.

BMJ Case Reports 2018; doi:10.1136/bcr-2018-224179