Necrotizing Fasciitis in a Patient on Long-Term Intramuscular Interferon-Beta for Multiple Sclerosis: A Case Report.

MedStar author(s):
Citation: Jbjs Case Connector. 10(1):e0288, 2020 Jan-Mar.PMID: 32224665Institution: MedStar Washington Hospital CenterDepartment: Surgery/Trauma SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Fasciitis, Necrotizing/et [Etiology] | *Immunologic Factors/ae [Adverse Effects] | *Interferon beta-1a/ae [Adverse Effects] | *Multiple Sclerosis, Relapsing-Remitting/dt [Drug Therapy] | *Shock, Septic/et [Etiology] | Debridement | Fasciitis, Necrotizing/su [Surgery] | Humans | Immunologic Factors/ad [Administration & Dosage] | Injections, Intramuscular/ae [Adverse Effects] | Interferon beta-1a/ad [Administration & Dosage] | Male | Middle Aged | Multiple Sclerosis, Relapsing-Remitting/co [Complications]Year: 2020ISSN:
  • 2160-3251
Name of journal: JBJS case connectorAbstract: CASE: Immunomodulatory injections are becoming common long-term treatments for neuromuscular diseases such as multiple sclerosis (MS), although they carry a risk of local site infection. We describe a case of a 57-year-old man who developed necrotizing fasciitis of the anterior thigh secondary to intramuscular (IM) injections of interferon-beta-1A for MS, ultimately developing septic shock and requiring serial debridements for source control.CONCLUSIONS: This is the first reported case of necrotizing fasciitis from chronic IM injections for MS and deserves particular attention because of the immunosuppressive nature of the injections. In patients with underlying predisposing factors for infection, such as decubitus ulcers, it may be prudent to reconsider the administration route. Patients in hypermetabolic states should be closely monitored for impaired response to infections.All authors: McDaniel C, Trankiem COriginally published: Jbjs Case Connector. 10(1):e0288, 2020 Jan-Mar.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2020-07-09
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Journal Article MedStar Authors Catalog Article 32224665 Available 32224665

CASE: Immunomodulatory injections are becoming common long-term treatments for neuromuscular diseases such as multiple sclerosis (MS), although they carry a risk of local site infection. We describe a case of a 57-year-old man who developed necrotizing fasciitis of the anterior thigh secondary to intramuscular (IM) injections of interferon-beta-1A for MS, ultimately developing septic shock and requiring serial debridements for source control.

CONCLUSIONS: This is the first reported case of necrotizing fasciitis from chronic IM injections for MS and deserves particular attention because of the immunosuppressive nature of the injections. In patients with underlying predisposing factors for infection, such as decubitus ulcers, it may be prudent to reconsider the administration route. Patients in hypermetabolic states should be closely monitored for impaired response to infections.

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