INTRODUCTION: Necrotising fasciitis is a severe infection characterised by the fulminant destruction of tissue with associated systemic signs of sepsis and toxicity. Etanercept is a fully human fusion protein that inhibits tumor necrosis factor and the inflammatory cascade. It is effective in the treatment of many disorders but concerns regarding severe life threatening infections have been raised in multiple reports. CASE PRESENTATION: We present the case of a 39-year-old Caucasian man, who presented with sudden onset of severe and progressive neck and left shoulder pain, with a two-year history of seronegative rheumatoid arthritis treated with azathoprine and etanercept. On examination the left side of his neck and his left shoulder were oedematous, tender with an erythematous rash and his active range of movement was limited. Magnetic resonance imaging of his shoulder showed extensive oedema of the subcutaneous and intramuscular fat of the left lower neck consistent with fasciitis. He was treated medically and made a good recovery. CONCLUSION: Our patient, while having a pre-existing increased mortality risk, had a serious infection which responded well to optimum medical treatment without the need for surgery. As anti tumor necrosis factor agents are frequently associated with infection, including tuberculous infection, this case highlights the need for a high index of suspicion for other severe bacterial infections in patients on immunosuppressants.
INTRODUCTION:Necrotising fasciitis is a severe infection characterised by the fulminant destruction of tissue with associated systemic signs of sepsis and toxicity. Etanercept is a fully human fusion protein that inhibits tumor necrosis factor and the inflammatory cascade. It is effective in the treatment of many disorders but concerns regarding severe life threatening infections have been raised in multiple reports. CASE PRESENTATION: We present the case of a 39-year-old Caucasian man, who presented with sudden onset of severe and progressive neck and left shoulder pain, with a two-year history of seronegative rheumatoid arthritis treated with azathoprine and etanercept. On examination the left side of his neck and his left shoulder were oedematous, tender with an erythematous rash and his active range of movement was limited. Magnetic resonance imaging of his shoulder showed extensive oedema of the subcutaneous and intramuscular fat of the left lower neck consistent with fasciitis. He was treated medically and made a good recovery. CONCLUSION: Our patient, while having a pre-existing increased mortality risk, had a serious infection which responded well to optimum medical treatment without the need for surgery. As anti tumor necrosis factor agents are frequently associated with infection, including tuberculous infection, this case highlights the need for a high index of suspicion for other severe bacterial infections in patients on immunosuppressants.
Authors: J M Bathon; R W Martin; R M Fleischmann; J R Tesser; M H Schiff; E C Keystone; M C Genovese; M C Wasko; L W Moreland; A L Weaver; J Markenson; B K Finck Journal: N Engl J Med Date: 2000-11-30 Impact factor: 91.245
Authors: Ben J Childers; Louis D Potyondy; Ryan Nachreiner; Frank R Rogers; Ellyn R Childers; Kerby C Oberg; Douglas L Hendricks; Robert A Hardesty Journal: Am Surg Date: 2002-02 Impact factor: 0.688
Authors: Johan Askling; C Michael Fored; Lena Brandt; Eva Baecklund; Lennart Bertilsson; Lars Cöster; Pierre Geborek; Lennart T Jacobsson; Staffan Lindblad; Jörgen Lysholm; Solbritt Rantapää-Dahlqvist; Tore Saxne; Victoria Romanus; Lars Klareskog; Nils Feltelius Journal: Arthritis Rheum Date: 2005-07
Authors: Sebastian Schneeweiss; Soko Setoguchi; Michael E Weinblatt; Jeffrey N Katz; Jerry Avorn; Paul E Sax; Raisa Levin; Daniel H Solomon Journal: Arthritis Rheum Date: 2007-06
Authors: C J Fisher; J M Agosti; S M Opal; S F Lowry; R A Balk; J C Sadoff; E Abraham; R M Schein; E Benjamin Journal: N Engl J Med Date: 1996-06-27 Impact factor: 91.245