Necrotising fasciitis in a patient receiving infliximab for rheumatoid arthritis

A case of necrotising fascitis in a patient receiving infliximab, an antitumour necrosis factor alpha (TNF-alpha) agent for rheumatoid arthritis, is presented A widespread confluent, erythematous, pustular skin rash was the presenting sign. There was nos fever throughout this admission. beta-Haemolytic group A streptocccus was isolated from blood cultures and skin swabs. The adductor muscles and fascia around the site of a previous hip arthroplasty were necrotic on exploration. The case highlights the risk of severe sepsis in patients on anti-TNF-alpha treatment.