Is a person with lupus at increased risk of infection with flesh-eating bacteria?
Yes, for two reasons.
First, lupus itself makes a person more likely to get all kinds of infections, from colds to skin wounds.
That's ironic, because lupus itself is caused by a hyperactive immune system that turns against a person's own body. But the disease also involves a defective immune response to bacteria and to viruses.
The second reason is that immunity-suppressing drugs really help people with lupus.
"But patients pay a price: side effects. And the most common side effect is infection," Putterman says. "Lupus drugs suppress the same immune responses needed to protect you against foreign invaders such as bacteria."
Are people with lupus at higher risk of necrotizing fasciitis than other people with immune suppression?
That's not yet clear, because infection with flesh-eating bacteria is so rare. But Putterman's team was able to find eight cases in lupus patients at a single hospital.
This suggests "that a heightened awareness is warranted, particularly among lupus patients who are immunosuppressed by virtue of their underlying disease, the therapy they require, or both," Putterman and colleagues write in their report.
I have lupus. What can I do to cut my risk of infection with flesh-eating bacteria?
Over time, a person with lupus may have fewer or more symptoms. This means that a person with lupus doesn't always need the same dose of immune-suppressing drugs.
It's extremely important for lupus patients to regularly see a doctor with experience treating the disease. With regular checkups, lupus patients can be sure they are getting the right dose of medication.
Too much medication puts a lupus patient at risk of infection from unnecessary immune suppression. Too little medication puts a lupus patient at risk of infection from unnecessarily severe disease.
"If you get regular follow-up with a doctor who treats lupus, they would make sure you are getting the specific amount of treatment you need for your disease and no more," Putterman says. "We constantly battle to find the most effective dose of medication without over-suppressing the immune system."