Necrotizing fasciitis resulting from Escherichia coli in a patient with chronic rheumatoid arthritis

A middle-aged woman with rheumatoid arthritis was admitted because of cellulitis on the leg. Twenty-four hours after admission haemorrhagic blisters and bullae appeared on the lower extremity. Despite intensive therapy she died due to multiple organ failure at 50 h after admission. Post-mortem examination revealed diffuse necrosis of fascia in her leg. Bacteriological study showed Escherichia coli in her blood cultures and fluid from a bulla, indicating that she had necrotizing fasciitis resulting from Escherichia coli. Necrotizing fasciitis is an uncommon but potentially fatal infection; thus, this disease should be considered in the differential diagnosis of any cutaneous manifestations in patients with rheumatoid arthritis.