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Lupus
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Necrotizing fasciitis in rheumatic diseases

M Y Mok

University Department of Medicine, Queen Mary Hospital, Hong Kong, mymok{at}netvigator.com

S Y Wong

Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong

T M Chan

University Department of Medicine, Queen Mary Hospital, Hong Kong

W M Tang

University Department of Medicine, Queen Mary Hospital, Hong Kong

W S Wong

University Department of Medicine, Queen Mary Hospital, Hong Kong

C S Lau

Department of Orthopaedics and Traumatology, University Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong

Necrotizing fasciitis is an uncommon but life-threatening complication in immunocompromised hosts. We reported four patients with rheumatic diseases complicated by necrotizing fasciitis and reviewed 14 others from literature search. Most patients were on corticosteroid treatment. Septic shock, disseminated intravascular coagulopathy and acute renal deterioration were common giving rise to an overall mortality rate of 27.8%. Septic arthritis may also complicate the condition. Statistical analysis on the series showed the lack of major surgical debridement as the only risk factor associated with increased mortality (RR 7.5, 95% CI 2.1-27.3, P = 0.01). Timely debridement of necrotic tissue is important for reducing mortality.

Key Words: infection • immunocompromised hosts • ßhaemolytic streptococcus

Lupus, Vol. 15, No. 6, 380-383 (2006)
DOI: 10.1191/0961203306lu2314cr
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