Necrotizing fasciitis in rheumatic diseases.
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.
Mok
M Y
MY
University Department of Medicine, Queen Mary Hospital, Hong Kong. mymok@netvigator.com
Wong
S Y
SY
Chan
T M
TM
Tang
W M
WM
Wong
W S
WS
Lau
C S
CS
D000328:Adult; D000333:Aeromonas / Q000302:isolation & purification; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000209:etiology; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D019644:Arthroplasty, Replacement, Hip; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D003646:Debridement; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D019115:Fasciitis, Necrotizing / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D005271:Femur Head Necrosis / Q000139:chemically induced / Q000601:surgery; D005399:Fishes / Q000382:microbiology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D045743:Scleroderma, Diffuse / Q000150:complications* / Q000188:drug therapy; D012772:Shock, Septic / Q000209:etiology; D012867:Skin / Q000293:injuries; D016038:Skin Transplantation; D013290:Streptococcal Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D013530:Surgical Wound Infection / Q000209:etiology
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone