Necrotizing fasciitis in a patient with rheumatoid arthritis treated with tocilizumab

Excerpt

Fujiwara et al. [1] reported two cases of patients with rheumatoid arthritis (RA) who developed pneumonia with only minimal clinical symptoms during treatment with the anti-interleukin-6 (IL-6) receptor monoclonal antibody tocilizumab. Physicians who treat patients receiving tocilizumab should recognize that this biologic agent may delay or mask inflammatory laboratory findings in infections. We present here a case of necrotizing fasciitis, a life-threatening skin infection, with masked inflammatory laboratory findings occurring in a patient with RA treated with tocilizumab. A literature search of the PubMed database identified three documented cases of necrotizing fasciitis in patients with RA receiving anti-tumor necrosis factor (TNF) therapies, infliximab, or etanercept; two of them were fatal [2‐4]. To our knowledge, there are no other published reports of necrotizing fasciitis in association with tocilizumab treatment. …