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Fulminant necrotising fasciitis developing during long term corticosteroid treatment of systemic lupus erythematosus
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  1. N Hashimoto1,
  2. H Sugiyama1,
  3. K Asagoe2,
  4. K Hara2,
  5. O Yamasaki2,
  6. Y Yamasaki1,
  7. H Makino1
  1. 1Department of Medicine and Clinical Science (Department of Medicine III), Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
  2. 2Department of Dermatology, Okayama University Graduate School of Medicine and Dentistry
  1. Correspondence to:
    Dr N Hashimoto;
    hashid{at}mail.goo.ne.jp

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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.

CASE REPORT

A 58 year old Japanese woman, who had been receiving oral prednisolone treatment for SLE for 20 years, was admitted to our hospital because of a swollen …

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