Systemic lupus erythematosus developing immediately after necrotizing fasciitis.

Necrotizing fasciitis (NF) is a medical-surgical emergency characterized by severe bacterial infection that affects the subcutaneous tissue and spreads to the underlying fascia; usually it is caused by penetrating trauma, sometimes by surgical therapy, very rarely by minor insults such as insect bites. Systemic lupus erythematosus (SLE) is a potentially fatal autoimmune disease involving virtually all the key components of the immune system. Although cases of post-infection autoimmunity were already described, a literature search using Pub Med and Medline revealed that SLE was never reported to occur in patients affected, immediately before, with NF. We observed and herein report, however, a case of a woman showing an insect-bite-induced NF, which was immediately followed by the development of a SLE. In conclusion, this case of postinfection autoimmunity provides early evidence of a patient developing SLE immediately after NF, and suggests that caution in the follow-up of NF is necessary, because NF might favor the development of a severe autoimmunity.

[Evaluation of the efficacy and tolerance of BPAA gel in 48 patients with extra-articular rheumatic diseases and in 52 patients with osteoarthritis in the painful phase. Open non-comparative study]. / Valutazione di efficacia e tollerabilità del BPAA gel su 48 pazienti affetti da forme reumatiche extra-articolari e su 52 pazienti affetti da osteoartrosi in fase dolorosa. Studio aperto non comparativo.

An open trial was carried out in 100 outpatients suffering from osteoarthritis (52 subjects) or extra-articular rheumatic disorders (48 subjects). Treatment consisted in topical application 3 times daily of an experimental product, BPAA gel, with 3% of active substance, for 2 weeks. During treatment the use of steroidal and non-steroidal analgesic and antiinflammatory agents or of any other drug apt to interfere with the parameters of evaluation was carefully avoided. Patients cooperated actively in subjective evaluation of pain parameters (Visual Analogue Self-rating Scale) which was used to integrate objective evaluation. Treatment response was very favorable, the drug proving effective in 83% and fairly effective in 5.7% of patients with osteoarthritis (total 88.7%). The corresponding figures for patients with extra-articular rheumatic disorders were 83.4% and 6.2% (total 89.0%). No local or systemic side-effects were observed in any of the 100 patients, nor did laboratory tests reveal any untoward actions of the drug.