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Facial Necrotizing Fasciitis Disclosing Systemic Lupus Erythematosus

Authors
Journal
Indian Journal of Dermatology
0019-5154
Publisher
Medknow Publications
Publication Date
Volume
58
Issue
2
Identifiers
DOI: 10.4103/0019-5154.108105
Keywords
  • E-Correspondence
Disciplines
  • Agricultural Science
  • Biology
  • Medicine

Abstract

Sir, We report a case of a 28-year-old female who developed facial necrotizing fasciitis due to trivial trauma on face, which started with left-sided facial swelling, pain and fever. Later, overlying skin on that side of the face became black, showing areas of necrosis with yellowish slough and pus discharge [Figure 1]. There was neither any history of diabetes, hypertension, tuberculosis or autoimmune disorder nor any history of treatment with corticosteroids. On laboratory investigation, apart from hemoglobin of 9.6 mg% and total leukocyte count of 17000/cm with 80% polymorphs, other parameters were normal. Her enzyme-linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) was negative. Chest X-ray, ultrasonogram of abdomen and computerized tomography (CT) scan of paranasal sinuses were normal. She underwent surgical debridement of necrotic tissue and irrigation with normal saline solution and hydrogen peroxide until bleeding tissue was encountered, after having been diagnosed with necrotizing fasciitis. Culture of debrided tissue was suggestive of Pseudomonas species sensitive to ciprofloxacin and was treated with daily dressing and injectable ciprofloxacin for 2 weeks. Considering the clinical picture and rapid development of fasciitis, antinuclear antibody (ANA) and antidouble-stranded DNA (anti-dsDNA) were done, which were strongly positive. We made a diagnosis of systemic lupus erythematosus (SLE) with necrotizing fasciitis. She was started with corticosteroids 1 mg per kg body weight. On follow-up, she was doing well with a maintenance dose of 10 mg per day. Figure 1 Left side of the face showing black necrotic tissue with pus discharge and slough at the margin Necrotizing fasciitis is a rare, soft tissue infection, primarily involving the skin and superficial fascia, resulting in extensive undermining of the surrounding tissues. If untreated, it has high morbidity and mortality, and thus a high index of suspicion for the diagnosi

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