title: An autopsy case of necrotizing fasciitis with rapidly progressive purpura caused by hemolytic streptococcal infection in a patient with rheumatoid arthritis.
abstract: A 77-year-old woman with rheumatoid arthritis was admitted as an emergency because of pain in the right leg with purpura. She was diagnosed with severe cellulitis and sepsis and started on intravenous antibiotics; however, the lesion rapidly extended to the proximal thigh and she died only 38 h after the onset of the first symptom. Autopsy and tissue culture revealed necrotizing fasciitis caused by Streptococcus dysgalactiae subspecies equisimilis. Physicians should consider that necrotizing fasciitis may be present when soft-tissue disorder is suspected in patients receiving corticosteroid therapy, which is associated with tissue fragility and immunosuppression.
authors.affiliation: Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392, Japan.
authors.forename: Kanako
authors.initials: K
authors.lastname: Iwata
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Arinuma
authors.forename: Hisanori
authors.initials: H
authors.lastname: Nakayama
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nogi
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Futami
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Takaoka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hashimoto
authors.forename: Kota
authors.initials: K
authors.lastname: Shimada
authors.forename: Akiko
authors.initials: A
authors.lastname: Komiya
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Matsui
authors.forename: Ikuo
authors.initials: I
authors.lastname: Saito
authors.forename: Shigeto
authors.initials: S
authors.lastname: Tohma
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000473:pathology*; D019115:Fasciitis, Necrotizing / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D011693:Purpura / Q000209:etiology / Q000473:pathology*; D013290:Streptococcal Infections / Q000150:complications / Q000473:pathology*; D013291:Streptococcus