Necrotizing Fasciitis in Systemic Lupus Erythematosus

Kamran, Muhammad; Wachs, Jane; Putterman, Chaim

doi:10.1016/j.semarthrit.2007.04.005

Cited by 20 publications

(11 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, Clostridium spores may remain dormant for many years before germination and resultant NF [10]. NF in SLE is uncommon [11] and Kamran et al state that only 13 cases were reported up to 2008 [12]. A dampened immune system due to immunosuppressive (azathioprine with prednisolone in our patient) therapy, the disease process per se [12] or skin fragility secondary to prednisolone [13] could be additional predisposing factors for patients with SLE to get NF.…”

Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis – a diagnostic dilemma: two case reports

et al. 2014

View full text Add to dashboard Cite

IntroductionNecrotizing soft tissue infections can affect various tissue planes. Although predisposing etiologies are many, they mostly center on impaired immunity occurring directly or indirectly and loss of integrity of protective barriers which predispose to infection. The nonspecific presentation may delay diagnosis and favor high mortality.Case presentationTwo case vignettes are presented. The first patient, a 44-year-old healthy South Asian man with a history of repeated minor traumatic injury presented to a primary health care center with a swollen left lower limb. He was treated with antibiotics with an initial diagnosis of cellulitis. Because he deteriorated rapidly and additionally developed intestinal obstruction, he was transferred to our hospital which is a tertiary health care center for further evaluation and management. Prompt clinical diagnosis of necrotizing soft tissue infection was made and confirmed on magnetic resonance imaging as necrotizing fasciitis. Urgent debridement was done, but the already spread infection resulted in rapid clinical deterioration with resultant mortality. The second patient was a 35-year-old South Asian woman with systemic lupus erythematous receiving immunosuppressive therapy who developed left lower limb pain and fever. Medical attention was sought late as she came to the hospital after 4 days. Her condition deteriorated rapidly as she developed septic shock and died within 2 days.ConclusionsNecrotizing fasciitis can be fatal when not recognized and without early intervention. Clinicians and surgeons alike should have a greater level of suspicion and appreciation for this uncommon yet lethal infection.

show abstract

Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis – a diagnostic dilemma: two case reports

et al. 2014

View full text Add to dashboard Cite

show abstract

“…9 The clinical presentation of patients with NF may be deceptively benign at onset, and it may not be possible to distinguish it clearly from minor soft tissue infections. Our patient was discharged from the original hospital before being admitted subsequently severely ill to University College Hospital.…”

Section: Discussionmentioning

confidence: 99%

“…The patient was also treated with hydroxychloroquine (HCQ), azathioprine (AZA) (100 mg from 1999 to 2009) and had 14 courses of cyclophosphamide (CYC) (a cumulative dose of 14 g) and two of rituximab (RTX) (two 1 g intravenous infusions separated by 2 weeks), the last being given in March 2012 for a SLE flare manifested by severe vasculitic rash. Immediately prior to B-cell depletion, her C3 level was 0.33 g/L (normal: 0.65-1.65), cluster designation (CD) 19 count was 0.146/µL (0.11-0.69), and immunoglobulin G level was 23.4 g/L (7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Case Reportmentioning

confidence: 99%

Necrotising fasciitis in systemic lupus erythematosus: a case report and literature review

Tung‐Chen

Isenberg

2014

Lupus Sci Med

View full text Add to dashboard Cite

Necrotising fasciitis (NF) is a rare infection of the subcutaneous tissue, known to be rapidly progressive and potentially fatal. Patients with systemic lupus erythematosus (SLE) may be predisposed to this condition, and early clinical recognition can be difficult. We report a case of necrotising fasciitis in a 26-year-old woman with SLE. She presented with painful swelling of her left leg, then developed clinical features of septic shock. Emergency debridement was performed. Intraoperative findings revealed NF and cultures grew Pseudomonas aeruginosa. The patient survived after a lengthy hospital admission, following several further debridements complicated by recurrent chest sepsis and multiorgan failure. We also review and discuss the published cases of NF in SLE patients.

show abstract

“…S. pneumoniae skin and soft-tissue infections are frequently documented, and are postulated to be a 'distinct clinical syndrome' given the propensity for upper body involvement (Hill & Karsh, 1997). S. pneumoniae has been documented to cause necrotizing fasciitis in SLE patients as well (Kamran et al, 2008). H. influenza infection has been reported less frequently, including septic arthritis (Borenstein & Simon, 1986) and soft-tissue infections (necrotizing fasciitis) (Robinson et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Severe infection with encapsulated bacteria as the initial presentation of systemic lupus erythematosus: two case reports and a review of the literature.

Shaughnessy

Segal

2014

JMM Case Reports

View full text Add to dashboard Cite

Introduction: Severe bacterial infection is an unusual initial presentation of systemic lupus erythematosus (SLE). Case presentation: We describe two cases of severe encapsulated bacterial infection in women with previously undiagnosed SLE. Conclusion: Hypocomplementaemia associated with SLE is an important infection risk and should be considered in the evaluation of patients who present with unusual and severe infection with encapsulated bacteria.

show abstract

Necrotizing Fasciitis in Systemic Lupus Erythematosus

Cited by 20 publications

References 27 publications

Necrotizing fasciitis – a diagnostic dilemma: two case reports

Necrotizing fasciitis – a diagnostic dilemma: two case reports

Necrotising fasciitis in systemic lupus erythematosus: a case report and literature review

Severe infection with encapsulated bacteria as the initial presentation of systemic lupus erythematosus: two case reports and a review of the literature.

Contact Info

Product

Resources

About