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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (6): 1198-1202. doi: 10.19723/j.issn.1671-167X.2025.06.028

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Rheumatoid arthritis complicated with necrotizing fasciitis: A case report

Xuebing LYU1, Xuanhua YU2,*(), Weizhen ZHANG1, Changquan LIU1, Huhan LIN1, Shanting ZENG1, Huijuan HUANG3, Yueping WU2   

  1. 1. The First Clinical Medical College of Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China
    2. Department of Rheumatology, People's Hospital Affiliated to Fujian University of Chinese Medicine, Fuzhou 350004, China
    3. Department of Preventive Treatment of Disease, People's Hospital Affiliated to Fujian University of Chinese Medicine, Fuzhou 350004, China
  • Received:2025-02-27 Online:2025-12-18 Published:2025-10-27
  • Contact: Xuanhua YU
  • Supported by:
    the Fujian Provincial Senior Talent Training Progam on Western Medicine Doctors Learning from Traditional Chinese Medicine(闽卫中医二函[2024]1969号)

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Abstract:

This case report describes the diagnostic and therapeutic management of a 70-year-old female patient with rheumatoid arthritis (RA) complicated by necrotizing fasciitis (NF).The patient has a history of RA for over 20 years, without previous standardized diagnosis or treatment.On October 3, 2023, the patient presented with swelling and pain in the bilateral proximal interphalangeal joints, the third metacarpophalangeal joint of the right hand, bilateral wrists, knees, and ankles, accompanied by redness, swelling, pain, and fever in the left gluteal region, perianal area, perineum, and the lateral upper segment of the right thigh. Laboratory tests revealed significantly elevated levels of rheumatoid factor, anti-cyclic citrullinated peptide antibodies, white blood cells, neutrophils, C-reactive protein, and erythrocyte sedimentation rate. CT imaging showed multiple large patchy areas of increased density with blurred margins in the subcutaneous adipose tissue of the bilateral gluteal regions and lower limbs, gluteus maximus muscles, and perineum, along with exudative changes in the subcutaneous adipose tissue of the bilateral lower limbs. Surgical exploration revealed extensive black necrotic tissue, and postoperative pathological examination indicated suppurative changes with abscess formation and inflammatory necrotic tissue, accompanied by local granulation tissue hyperplasia. Bacterial culture identified Staphylococcus aureus. Thus, the diagnosis of RA complicated with NF was confirmed. Following timely surgical intervention and antibiotic therapy, the patient is currently recovering satisfactorily. RA complicated with NF is relatively rare and associated with high mortality and a prolonged disease course. Elderly RA patients undergoing treatment with immunosuppressants, nonsteroidal anti-inflammatory drugs, and biologics should be highly vigilant for the risk of developing NF. Clinicians should enhance their understanding of RA complicated with NF, establish an early diagnosis, provide active treatment, and improve patient prognosis.

Key words: Arthritis, Rheumatoid, Fasciitis, Necrotizing

CLC Number: 

  • R686.3

Figure 1

CT images of patient's bilateral femur and tibia-fibula There are multiple large patchy areas of increased density in the subcutaneous fat tissue of both buttocks and lower extremities, gluteus maximus and perineum, with blurred margins. There are exudative changes in the subcutaneous fat tissue of both lower extremities, as indicated by the red arrows."

Figure 2

Pre-operative (A, B) and post-operative (C, D) pictures of the patient on October 8, 2023"

Figure 3

Surgical pathological results of patient (HE staining)"

Figure 4

Recovery status of the perianal/perineal region (A) and the lower limbs (B) on post-operative day 13"

Figure 5

Recovery of the perianal/perineal region (A to C) and lower limbs (D) at the 6-month postoperative follow-up"

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