Open Access Highly Accessed Case report

Necrotizing fasciitis caused by Haemophilus influenzae type b in a patient with rectal cancer treated with combined bevacizumab and chemotherapy: a case report

Tomotaka Ugai12*, Masataro Norizuki13, Takahiro Mikawa1, Goh Ohji4 and Makito Yaegashi1*

Author Affiliations

1 Division of General Internal Medicine and Infectious Disease, Department of Medicine, Kameda Medical Center, Kamogawa-shi, Chiba 296-8601, Japan

2 Current address; Division of Hematology, Department of Medicine, Saitama Medical Center, Jichi Medical University, Amanuma-cho, Omiya, Saitama-shi, Saitama 330-8503, Japan

3 Current address; Department of Infectious Disease, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan

4 Division of Infectious Disease, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan

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BMC Infectious Diseases 2014, 14:198  doi:10.1186/1471-2334-14-198

Published: 12 April 2014

Abstract

Background

Recently, necrotizing fasciitis has been reported in patients treated with bevacizumab, usually secondary to wound healing complications, gastrointestinal perforations, or fistula formation. The risk of invasive Haemophilus influenzae type b infection is significantly increased in immunocompromised hosts. However, necrotizing fasciitis due to Haemophilus influenzae type b in a patient treated with combined bevacizumab and chemotherapy has not been previously reported.

Case presentation

A 59-year-old woman was admitted to the intensive care unit after sudden onset of fever, chills, and right thigh pain. She received chemotherapy with fluorouracil, irinotecan, and bevacizumab for colon cancer 10 days prior to admission. The advancing erythematous margin and her worsening clinical condition prompted us to suspect necrotizing fasciitis and consult the orthopedics department for a fascia biopsy and debridement. Surgical exploration revealed a murky dishwater-colored pus exudate from the incision site and the lack of a shiny appearance of the fascia that also suggested necrotizing fasciitis. After 2 days, the final results of the blood and exudate cultures confirmed the presence of Haemophilus influenzae type b. A diagnosis of necrotizing fasciitis due to Haemophilus influenzae type b was made. The patient required recurrent surgical debridement and drainage, but she recovered from the septic shock.

Conclusions

We report a case of necrotizing fasciitis due to Haemophilus influenzae type b in a patient without injury and with rectal cancer treated with combined bevacizumab and chemotherapy. Physicians should consider invasive Haemophilus influenzae type b disease in the presence of necrotizing fasciitis in patients treated with this combined treatment modality.

Keywords:
Necrotizing fasciitis; Haemophilus influenzae type b; Bevacizumab