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황준일 ( Jun Eul Hwang ),우학 ( Hak Woo ),김상호 ( Sang Ho Kim ),이우석 ( Woo Seok Lee ),황재하 ( Jae Ha Hwang ),김정철 ( Jung Chul Kim ),조덕 ( Duck Cho ),박정진 ( Jeong Jin Park ),이신석 ( Shin Seok Lee ),박용욱 ( Yong Wook Pa 대한류마티스학회 2006 대한류마티스학회지 Vol.13 No.2
Necrotizing fasciitis is a life-threatening soft tissue infection involving skin, subcutaneous tissue, and superficial fascia. We report a case of necrotizing fasciitis that developed in a 76-year-old female patient taking low-dose methotrexate and prednisolone for rheumatoid arthritis (RA). A computed tomography scan of the neck during the initial work-up showed soft tissue swelling, loss of fat planes, and mild heterogeneous enhancement in the right lateral neck, suggesting cellulitis. The lesions were associated with skin necrosis and multiple bullae rapidly expanded to the right anterior chest in spite of empirical antibiotic therapy. Surgical debridement was immediately performed, and soft tissue biopsy from the lesions showed the pathologic finding consistent with necrotizing fasciitis. The skin wound defect was reconstructed by a flap operation with split-thickness skin graft. This case shows the development of necrotizing fasciitis in a elderly patient taking methotrexate and low-dose steroid for RA and highlights early recognition and prompt surgical debridement for successful management.