Department of Orthopaedic Surgery, Johns Hopkins University Hospital, Baltimore, Maryland.
Department of Critical Care and Trauma Surgery, Medstar Washington Hospital Center, Washington, DC.
JBJS Case Connect. 2020 Jan-Mar;10(1):e0288. doi: 10.2106/JBJS.CC.19.00288.
Immunomodulatory injections are becoming common long-term treatments for neuromuscular diseases such as multiple sclerosis (MS), although they carry a risk of local site infection. We describe a case of a 57-year-old man who developed necrotizing fasciitis of the anterior thigh secondary to intramuscular (IM) injections of interferon-beta-1A for MS, ultimately developing septic shock and requiring serial debridements for source control.
This is the first reported case of necrotizing fasciitis from chronic IM injections for MS and deserves particular attention because of the immunosuppressive nature of the injections. In patients with underlying predisposing factors for infection, such as decubitus ulcers, it may be prudent to reconsider the administration route. Patients in hypermetabolic states should be closely monitored for impaired response to infections.
免疫调节注射已成为多发性硬化症（MS）等神经肌肉疾病的常见长期治疗方法，但它们存在局部感染的风险。我们描述了一例 57 岁男性患者，他因多发性硬化症接受干扰素-β-1A 的肌肉内（IM）注射后发生大腿前侧坏死性筋膜炎，最终发展为感染性休克，需要进行多次清创以控制感染源。
这是首例报道的由多发性硬化症的慢性 IM 注射引起的坏死性筋膜炎病例，由于注射具有免疫抑制性质，因此应特别注意。对于存在感染易感因素（如褥疮）的患者，可能需要重新考虑给药途径。代谢亢进的患者应密切监测其对感染的反应受损情况。
