Abstract
We first report a case of patient with refractory dermatomyositis (DM) who successfully treated with tumor necrosis factor-α blocker, etanercept and developed necrotizing fasciitis (NF) after the use of it. NF was diagnosed early by MRI and managed with antimicrobial therapy and timely debridement of necrotic tissue with favorable outcome. We suggest that etanercept can be a useful therapeutic agent in patients with DM refractory to steroid and immunosuppressive agents and NF may occur in DM in association with etanercept therapy. We also suggest that management strategies for early diagnosis and treatment are needed for this complication.
References
Callen JP (2000) Dermatomyositis. Lancet 355:53–57. doi:10.1016/S0140-6736(99)05157-0
Danko K, Ponyi A, Constantin T, Borgulya G, Szegedi G (2004) Long-term survival of patients with idiopathic inflammatory myopathies according to clinical features: a longitudinal study of 162 cases. Medicine (Baltimore) 83:35–42. doi:10.1097/01.md.0000109755.65914.5e
Sprott H, Glatzel M, Michel BA (2004) Treatment of myositis with etanercept (Enbrel), a recombinant human soluble fusion protein of TNF-alpha type II receptor and IgG1. Rheumatology (Oxford) 43:524–526. doi:10.1093/rheumatology/keh062
Hengstman GJ, van den Hoogen FH, Barrera P, Netea MG, Pieterse A, van de Putte LB et al (2003) Successful treatment of dermatomyositis and polymyositis with anti-tumor-necrosis-factor-alpha: preliminary observations. Eur Neurol 50:10–15. doi:10.1159/000070852
Hengstman GJ, van den Hoogen FH, van Engelen BG (2004) Treatment of dermatomyositis and polymyositis with anti-tumor necrosis factor-alpha: longterm follow-up. Eur Neurol 52:61–63. doi:10.1159/000079547
Efthimiou P, Schwartzman S, Kagen LJ (2006) Possible role for tumour necrosis factor inhibitors in the treatment of resistant dermatomyositis and polymyositis: a retrospective study of eight patients. Ann Rheum Dis 65:1233–1236. doi:10.1136/ard.2005.048744
Maynor M, Kardon E, Talavera F, Weiss E, Halamaka J, Feied C Necrotizing fasciitis. eMedicine. Available at http://www.emedicine.com/emerg/topic332.htm. [Accessed 12 May 2005]
McEntegart A, Capell HA (2002) Necrotizing fasciitis in a patient with rheumatoid arthritis. Rheumatology (Oxford) 41:828–829. doi:10.1093/rheumatology/41.7.828
Hashimoto N, Sugiyama H, Asagoe K, Hara K, Yamasaki O, Yamasaki Y et al (2002) Fulminant necrotising fasciitis developing during long term corticosteroid treatment of systemic lupus erythematosus. Ann Rheum Dis 61:848–849. doi:10.1136/ard.61.9.848
Marie I, Hachulla E, Chérin P, Hellot MF, Herson S, Levesque H et al (2005) Opportunistic infections in polymyositis and dermatomyositis. Arthritis Rheum 53:155–165. doi:10.1002/art.21083
Lundberg IE, Dastmalchi M (2002) Possible pathogenic mechanisms in inflammatory myopathies. Rheum Dis Clin North Am 28:799–822. doi:10.1016/S0889-857X(02)00025-X
Pachman LM, Liotta-Davis MR, Hong DK, Kinsella TR, Mendez EP, Kinder JM et al (2000) TNFalpha-308A allele in juvenile dermatomyositis: association with increased production of tumor necrosis factor alpha, disease duration, and pathologic calcifications. Arthritis Rheum 43:2368–2377. doi:10.1002/1529-0131(200010)43:10<2368::AID-ANR26>3.0.CO;2-8
Tateyama M, Nagano I, Yoshioka M, Chida K, Nakamura S, Itoyama Y (1997) Expression of tumor necrosis factor-alpha in muscles of polymyositis. J Neurol Sci 146:45–51. doi:10.1016/S0022-510X(96)00280-8
Oddis CV, Rider LG, Reed AM, Ruperto N, Brunner HI, Koneru B, International Myositis Assessment and Clinical Studies Group et al (2005) International consensus guidelines for trials of therapies in the idiopathic inflammatory myopathies. Arthritis Rheum 52:2607–2615. doi:10.1002/art.21291
Weinblatt ME, Kremer JM, Bankurst AD, Bulpitt KJ, Fleischmann RM, Fox RI et al (1999) A trial of etanercept, a recombinant tumor necrosis factor receptor: Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate. N Engl J Med 340:253–259. doi:10.1056/NEJM199901283400401
Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH, Keystone EC et al (2000) A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med 343:1586–1593. doi:10.1056/NEJM200011303432201
Chan AT, Cleeve V, Daymond TJ (2002) Necrotising fasciitis in a patient receiving infliximab for rheumatoid arthritis. Postgrad Med J 78:47–48. doi:10.1136/pmj.78.915.47
Sultan SM, Ioannou Y, Moss K, Isenberg DA (2002) Outcome in patients with idiopathic inflammatory myositis: morbidity and mortality. Rheumatology (Oxford) 41:22–26. doi:10.1093/rheumatology/41.1.22
Jarrett P, Rademaker M, Duffill M (1997) The clinical spectrum of necrotizing fasciitis. A review of 15 cases. Aust N Z J Med 27:29–34
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Choi, KH., Yoo, WH. Necrotizing fasciitis in a patient treated with etanercept for dermatomyositis. Rheumatol Int 29, 463–466 (2009). https://doi.org/10.1007/s00296-008-0695-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-008-0695-4