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These conditions are treated with rheumatological immunosuppressive medications and glucocorticosteroids. diagnosis of necrotising fasciitis early. Necrotising fasciitis may result from any major or minor injury to the skin such as needle puncture, insect bites, burns, lacerations, surgical wounds or blunt trauma that can act as an entry point for the causative organism. However, an entry point for bacteria cannot always be determined and this is also the case for our patient. Common co-morbidities predisposing to necrotising fasciitis are diabetes mellitus, malignancies and connective tissue disorders such as rheumatoid arthritis/systemic lupus erythematosus. These conditions are treated SNT-207707 with rheumatological immunosuppressive medications and glucocorticosteroids. The patient in this case report was taking 10?mg of prednisolone daily for asthma for several years. The association of steroid treatment with necrotising fasciitis has been reported previously.3 Angoules et?al. analysed the literature on necrotising fasciitis between 1992 and 2007 and they concluded that 3% of the documented necrotising fasciitis cases were associated with corticosteroid therapy. On the contrary, there is no direct mention of an association between asthma and necrotising fasciitis.4 After analysing 131 papers, Angoules et?al. found examples in the literature indicating that chronic kidney disease was related with 3% of necrotising fasciitis cases,4 mirroring the risk caused by corticosteroids. There are other examples of case reports that indicate that there is a link between SNT-207707 chronic kidney disease and necrotising fasciitis; however, they are usually associated with either renal transplants or haemodialysis.5,6 Despite the patient having no history of renal transplant or haemodialysis for his stage III chronic kidney disease, immunosuppression should not be overlooked as a possible predisposing factor as there are plenty of examples in the literature suggesting that chronic kidney disease itself is SNT-207707 associated with immunosuppression.6 Angoules et?al. further speculated that alcoholic liver disease was a significant predisposing factor present in 17% of the cases in his review.4 The final co-morbidity that should be considered is monoclonal gammopathy of undetermined significance, a premalignant disorder involving abnormal proliferation of monoclonal plasma cells in the bone marrow. Patients with monoclonal gammopathy of undetermined SNT-207707 significance have a lifelong risk of multiple myeloma which is associated with a median survival of 4C5 years. In 2012, Kristinsson et?al. reported on a monoclonal gammopathy of undetermined significance cohort from a national hospital network in Sweden between 1965 and 2005 that compared 5326 monoclonal gammopathy of undetermined significance patients and 20,161 population matched controls. Patients with monoclonal gammopathy of undetermined significance in his study had a 2.1-fold (95% confidence interval: 2.0C2.3) increased risk of developing bacterial infections (osteomyelitis, septicaemia, pyelonephritis, cellulitis, endocarditis and meningitis) and viral infections (influenza and herpes zoster) ( em p /em ? ?0.05). At 5?- to 10-year follow-up, 377 monoclonal gammopathy of undetermined significance patients (7.1%) were found to have more than one infection compared to 550 control patients (2.3%) during the same period of time.7 An earlier and smaller study was conducted in Denmark by Gregersen et?al. which similarly found that patients with monoclonal gammopathy of undetermined significance have a two-fold increased risk of suffering with bacterial infections.8 The predisposition to infection in monoclonal gammopathy of undetermined significance patients may be associated with a defective polyclonal immunoglobulin antibody response. Similar defects are observed in patients with multiple myeloma and SNT-207707 Waldenstr?m macroglobulinemia.9,10 There are numerous reports of patients with multiple myeloma developing infections including necrotising fasciitis11 but a direct connection with monoclonal gammopathy of undetermined significance has not been reported despite there being examples of patients in case reports suffering with monoclonal gammopathy of undetermined significance and contracting necrotising fasciitis.12 Conclusions Our case raises the possibility that monoclonal gammopathy of undetermined significance, which is considered a precursor of multiple myeloma, can also lead to necrotising fasciitis, although because of the simultaneous presence of additional predisposing factors, a definitive connection cannot be made based on our case alone. Acknowledgements The authors thank Roisin Bevan for her ongoing support and advice. Declarations Competing Interests None declared. Funding None declared. Ethics approval Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Guarantor JXV Contributorship JXV: Conception, research and design of the case report; obtaining informed consent from patient; E2F1 first draft of case report; revision and subsequent final approval of the version to be submitted. RPJ: Guidance throughout and subsequent final approval of the version to be submitted. Provenance Not commissioned; peer-reviewed by Daniel Marks..