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| CASE REPORT |
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| Year : 2015 | Volume
: 7
| Issue : 1 | Page : 22-24 |
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Gangrenous peri-orbital cellulitis in Nigerian children with post-measles malnutrition
Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| Date of Web Publication | 17-Jun-2015 |
Correspondence Address:
Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1858-540X.158994
Measles occurs in Nigeria on almost yearly basis despite availability of preventable vaccines. Though the integument is mostly affected, other organs may be involved. Common eye problem associated with measles is xeropthalmia which is due to vitamin A deficiency; however, the case of four children who presented with extensive gangrenous ocular infection with sparing of the oral cavity and cheek is reported.
Keywords: Gangrene, measles, ocular infection
How to cite this article:
Aliyu I. Gangrenous peri-orbital cellulitis in Nigerian children with post-measles malnutrition. Sudanese J Ophthalmol 2015;7:22-4 |
| Introduction | |  |
Measles still remains a public health problem in developing countries despites availability of vaccines. Outbreaks in Nigeria often occur on yearly basis especially between the months of January and May; but the impact of the disease could be felt long after such episode: Among these is post-measles malnutrition. Measles and malnutrition are immunosuppressants predisposing to infections; this is a report of four cases that developed gangrenous peri-orbital cellulitis following measles.
| Case Reports | | |
| Case 1 | | |
A 24-month-old-girl presented with 5-days history of swelling of the right eye lids which progressed with involvement of the left eye lids, this was associated with history of fever but no history of protrusion of the eye balls, convulsion or loss of consciousness. The child had measles 3 weeks before onset of the eye swelling and had been losing weight with diarrhoea. She was not vaccinated against measles, so were her siblings. Two days to presentation the mother noticed darkening of the swollen right eye lids with sloughing of the skin. On examination she was febrile (38.7°c) and wasted, weight for age z-score of <-3, mid-arm circumference of 10 cm; both eye-lids were swollen with gangrene of the left upper and lower eye lids and surrounding tissue [Figure 1] with exposure of the extra-ocular muscles but the oral cavity and cheek were not affected; full blood count showed elevated count of 12 × 10 9 /l (neutrophil-7.2 × 10 9 /l); tissue/blood cultures yielded no growth and she was human immunodeficiency virus (HIV) negative. She was placed on antibiotics and wound dressing.
| Case 2 | | |
An 18-month-old girl who also had measles 4-weeks before presentation; she was also not immunized for measles. Child had been unwell since having measles with progressive weight loss and diarrhoea; a week to presentation she developed bilateral eye lid swellings which later became gangrenous [Figure 2]; she was HIV negative and tissue/blood cultures also yielded no growth. She was placed on antibiotics and wound dressing but her clinical state deteriorated and she died on the second day of admission.
| Case 3 | | |
A 36-month-old boy who also had measles during the 2013 epidemic also developed bilateral eye swelling which progressively became necrotic and gangrenous [Figure 3]; he had significantly lost weight and his blood culture and HIV test were negative, he was hypoglycaemic on admission which was corrected but later died about 12 h on admission.
| Case 4 | | |
A 12-month-old boy also had measles during the same outbreak. He developed bilateral eye swellings 3 weeks after the desquamation of the rash; these swellings progressively increased with darkening of the upper eye-lids. These later sloughed with exposure of the eyeballs [Figure 4]; he was wasted with deranged anthropometry; blood culture and HIV test were negative; he was also hypoglycaemic at presentation which was corrected but he also died 24 h on admission.
| Discussion | | |
Measles has been associated with secondary soft tissue infection such as noma. [1],[2],[3] Typically in noma the infection and tissue necrosis starts intraorally as gingivistomatitis [4] with extension to the cheek but in these cases the oral cavities were spared; therefore it will be a misnomer to call this a ''noma oculi''; [5] often this is classified as a necrotizing fasciitis of the ocular tissues and it has been reported in immune-deficient individuals with acquired immunodeficiency syndrome; [6] and the commonly implicated organism is Streptococcus pyrogene [7] but our cases were HIV negative and the tissue/blood cultures were negative probably because of prior antibiotic use. These cases highlight the myriads of complications associated with measles infection; a disease that is easily preventable if proper vaccine utilization is ensured. Furthermore ocular infection may be a harbinger of a poor prognostic outcome as was witnessed in three out of the four cases.
| Conclusion | | |
Measles infection is still a huge health burden in the tropic and ocular infections can be devastating; therefore efforts should be geared toward preventing this disease through immunization.
| References | | |
| 1. | Baratti-Mayer D, Pittet B, Montandon D, Bolivar I, Bornand J, Hugonnet S, et al. Geneva Study Group onNoma. Noma: An "infectious" disease of unknown aetiology.Lancet Infect Dis 2013;3:419-31.  |
| 2. | Koz´ min´ ska-Kubarska A, Talleyrand D, Bakatubia M. Cutaneous complications during measles in Zairian children: Noma-like postmeasles ulcerations. Int J Dermatol 1982;21:465-9. |
| 3. | Bhaskaram P. Measles &malnutrition. Indian J Med Res 1995;102:195-9. |
| 4. | Eckstein A. Noma. Am J Dis Child 1940;59:219-37. |
| 5. | Chukwuka IO, Seleye-Fubara D, Etebu EN. Cancrum oculi in HIV positive child: A case report. PMJ 2007;2:81-2. |
| 6. | Francis BA, Mui AL, Calonje D. Orbital streptococcal gangrene and AIDS. Orbit2001;20:243-8. |
| 7. | Walters R. A fatal case of necrotising fasciitis of the eyelid. BrJOphthalmol1988;72:428-31. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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