A 56-year-old man, a lifelong resident of Norway, had received methotrexate for the past 15 years and infliximab for the past 11 years for seropositive rheumatoid arthritis and presented in 2025 with a 2-year history of progressive erythema, swelling, crusting, and epistaxis involving the right ear, nose, and cheek (figure A, B). He had previously received repeated courses of oral and intravenous anti-staphylococcal antibiotics for presumed facial cellulitis without improvement. Superficial cultures repeatedly grew Staphylococcus aureus and Streptococcus agalactiae, with persistently normal inflammatory markers.
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