• corticosteroids
• systemic lupus erythematosus
• fasciitis

Skin manifestations are some of the most common clinical symptoms and signs seen in patients with systemic lupus erythematosus (SLE). However, necrotising subcutaneous infection, in particular necrotising fasciitis, is rarely encountered. It is a rapidly progressive and destructive infection of the subcutaneous tissue, associated with mortality and long term morbidity of the affected patients.¹ We describe a patient with SLE and liver cirrhosis complicated by severe necrotising fasciitis who had been receiving corticosteroid treatment for 20 years. Necrotic skin tissue cultures grew both Staphylococcus aureus and Serratia marcescens. Despite aggressive treatment, including administration of antibiotics, emergency debridement, and total plasma exchange for severe liver damage, she died of disseminated intravascular coagulation and multiple organ failure owing to serious bacterial infection after two months in hospital. This case suggests that severe necrotising fasciitis may occur in SLE without lupus flare up during long term treatment with low dose corticosteroids.