Necrotizing fasciitis associated with primary cutaneous B-cell lymphoma. A case report

• Published in: Il Giornale di chirurgia 2017-05, Vol.38 (3), p.130-134
• Main Authors: Spiridakis, K G, Intzepogazoglou, D S, Flamourakis, M E, Sfakianakis, E E, Daskalaki, A V, Vakonaki, E K, Rahmanis, E, Kostakis, G E, Christodoulakis, M S
• Format: Article
• Language: English
• Subjects: Clinical Practice; Fasciitis, Necrotizing - complications; Fasciitis, Necrotizing - surgery; Female; Humans; Lymphoma, B-Cell - complications; Lymphoma, B-Cell - surgery; Middle Aged; Skin Neoplasms - complications; Skin Neoplasms - surgery
• ISSN: 0391-9005; 1971-145X
• DOI: 10.11138/gchir/2017.38.3.130

Necrotizing fasciitis is a rapidly progressive and life-threatening infection of the deeper skin layers and subcutaneous tissues that moves along the facial planes. We present the rare case of a patient with necrotizing fasciitis associated with high malignancy b-cell lymphoma. Our purpose is to investigate the probable connection between the two pathologies and evaluate the importance of early surgical intervention. 51-year old Caucasian woman presented at the E.R. with history of a painful left thigh over a week and fever up to 38,4°C over the last three days. Necrosis of the soft tissues and fascial planes were observed clinically. After the initial treatment and due to the patient's multiple organ dysfunction (septic shock), she was transferred to the ICU were she was intubated resuscitated with IV fluids and given IV antibiotics. 24 hours after the admission it was decided that the patient should undergo surgery and an extensive debridement of the necrotic area was performed. The antibiogram of the blood culture revealed streptococcus pyogenes and she was administered penicillin while intubated and monitored in the ICU until the seventh postoperative day. On the eighth post-day she was transferred back to the surgical department, hemodynamically normal and stable. She was discharged one month later and she was referred to a plastic surgery center for the final reconstruction surgery. This case highlights that the high index of suspicion and the early aggressive surgical intervention seems to be very critical to improve survival of the patients with necrotizing fasciitis.