Facial cellulitis secondary to chronic non-invasive ventilation

Excerpt

A 61-year-old man, on the waiting list for heart transplantation, was chronically treated at home for obstructive sleep apnoea with continuous positive airway pressure (auto-adjusted CPAP with heated humidifier, median pressure 13 cmH₂O) applied for 6 months through an oronasal mask (ResMed^® Quattro™). Air leaks frequently compelled the patient to increase the tightness of the straps; CPAP adherence was poor (3 h per night). The patient was admitted to the ICU for septic shock. Clinical examination revealed inflammatory and suppurative eyelids on a necrotic pressure sore of the left cheek (Fig. 1a). The computed tomography scan confirmed the diagnosis of left periorbital cellulitis (Fig. 1b). The evolution was favourable with medical treatment, including a 10-day mechanical invasive ventilation. The patient was discharged to home with nocturnal non-invasive ventilation (NIV) in the same way as before. Unfortunately, he presented a few days after with a recurrence of eyelid oedema. Finally, a full-face mask was successfully applied.

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