Tuberculous Necrotizing Fasciitis in a Patient with Rheumatoid Arthritis on Anti-TNF Treatment: A Case Report

Tuberculous necrotizing fasciitis (NF) is an exceedingly rare condition, particularly in patients undergoing immunosuppressive therapy for autoimmune diseases such as rheumatoid arthritis. This case describes a 69-year-old male with a history of rheumatoid arthritis treated with adalimumab, who presented with severe pain, swelling, and redness in the right upper limb. Despite initial treatment for presumed bacterial NF, histological examination and tuberculosis (TB) polymerase chain reaction (PCR) confirmed tuberculous fasciitis. The patient exhibited respiratory symptoms, and imaging revealed a cavitary lesion suggestive of pulmonary tuberculosis, which was also confirmed by sputum PCR. Unfortunately, the patient succumbed to an acute myocardial infarction during treatment. This case highlights the importance of considering TB in the differential diagnosis of necrotizing fasciitis, particularly in immunocompromised individuals, to ensure timely and appropriate management.