Vol.21 No.6

Case Report

An autopsy case of necrotizing fasciitis with rapidly progressive purpura caused by hemolytic streptococcal infection in a patient with rheumatoid arthritis

Authors

Kanako Iwata1 , Yoshiyuki Arinuma1 , Hisanori Nakayama1 , Shinichi Nogi1 , Hidekazu Futami1 , Hirokazu Takaoka1 , Atsushi Hashimoto1 , Kota Shimada1 , Akiko Komiya2 , Toshihiro Matsui1 , Ikuo Saito3 , Shigeto Tohma2

  • Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa, 252-0392, Japan
  • Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Kanagawa, 252-0392, Japan
  • Department of Pathology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Kanagawa, 252-0392, Japan
Received:

22 February 2011

Accepted:

25 March 2011

Published online:

17 April 2011

Full Text

PDF　(member's only)

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.

Key words

Necrotizing fasciitis - Streptococcus dysgalactiae subspecies equisimilis - Rheumatoid arthritis - Corticosteroid