Tuberculous Necrotizing Fasciitis in a Patient with Rheumatoid Arthritis on Anti-TNF Treatment: A Case Report

Area of Science:

• Infectious Diseases
• Rheumatology
• Pathology

Background:

• Tuberculous necrotizing fasciitis is an extremely rare condition.
• Immunosuppressive therapy for autoimmune diseases, like rheumatoid arthritis with adalimumab, increases susceptibility.
• Necrotizing fasciitis typically presents as a severe soft tissue infection.

Purpose of the Study:

• To report a rare case of tuberculous necrotizing fasciitis in an immunocompromised patient.
• To emphasize the importance of considering tuberculosis in the differential diagnosis of necrotizing fasciitis.
• To highlight diagnostic challenges and the need for prompt management.

Main Methods:

• Clinical case presentation of a 69-year-old male with rheumatoid arthritis.
• Histological examination of affected tissue.
• Polymerase chain reaction (PCR) for tuberculosis (TB) on tissue and sputum samples.
• Imaging studies for pulmonary lesions.

Main Results:

• Histopathology and TB PCR confirmed tuberculous fasciitis.
• Pulmonary tuberculosis was diagnosed via imaging and sputum PCR.
• The patient experienced respiratory symptoms and presented with limb swelling and pain.

Conclusions:

• Tuberculous fasciitis should be considered in the differential diagnosis of necrotizing fasciitis, particularly in immunocompromised patients.
• Prompt diagnosis and appropriate anti-TB treatment are essential for management.
• This case underscores the diagnostic challenges posed by rare infections in patients with autoimmune diseases.