Kamran Mohammad, Wachs Jane, Putterman Chaim
Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
Semin Arthritis Rheum. 2008 Feb;37(4):236-42. doi: 10.1016/j.semarthrit.2007.04.005. Epub 2007 Jun 14.
Necrotizing fasciitis (NF) is an uncommon infection of the subcutaneous tissue and superficial fascia. Any delay in treatment can lead to catastrophic results with high mortality. It is well known that patients with systemic lupus erythematosus (SLE) are at increased risk of infection, from the disease and/or its treatment. The objective of our study was to evaluate the presenting features of NF in SLE patients and to identify possible risk factors for this severe complication.
We searched for patients with diagnoses of SLE and NF using a computerized patient database at Montefiore Medical Center (MMC), from 1996 to present. We also included patients from the MMC Lupus Clinic with these diagnoses (identified from paper records) from 1994 to present. Of a total of 449 patients with SLE that were followed during this time, 8 patients with NF were identified, and their records were reviewed.
Two of the 8 patients (25%) died during hospitalization. A third patient died within 2 months of hospital discharge. All 8 patients were receiving steroids at the time of diagnosis, and 7 of 8 had hypoalbuminemia and lymphopenia. Both patients who died in the hospital and the one patient who died within 2 months of her discharge had lupus nephritis.
NF is an uncommon infection, but one that must be recognized early if the outcome is to be favorable. This series of 8 cases of NF in SLE from a single institution suggests that heightened awareness is warranted, particularly among SLE patients who are immunosuppressed by virtue of their underlying disease, the therapy they require, or both.
坏死性筋膜炎（NF）是一种罕见的皮下组织和浅筋膜感染。治疗的任何延迟都可能导致灾难性后果和高死亡率。众所周知，系统性红斑狼疮（SLE）患者因疾病本身和/或其治疗而感染风险增加。我们研究的目的是评估SLE患者中NF的临床表现，并确定这种严重并发症的可能危险因素。
我们使用蒙特菲奥里医疗中心（MMC）的计算机化患者数据库，搜索1996年至今诊断为SLE和NF的患者。我们还纳入了1994年至今MMC狼疮诊所诊断为这些疾病的患者（从纸质记录中识别）。在此期间随访的449例SLE患者中，确定了8例NF患者，并对他们的记录进行了回顾。
8例患者中有2例（25%）在住院期间死亡。第三例患者在出院后2个月内死亡。所有8例患者在诊断时均接受类固醇治疗，8例中有7例存在低白蛋白血症和淋巴细胞减少。在医院死亡的2例患者和出院后2个月内死亡的1例患者均患有狼疮性肾炎。
NF是一种罕见的感染，但如果要取得良好的预后，必须尽早识别。这一系列来自单一机构的8例SLE合并NF病例表明，有必要提高认识，特别是在那些因基础疾病、所需治疗或两者而免疫抑制的SLE患者中。
