INTRODUCTION: Chemotherapy is the mainstay of cancer treatment. Hematological side effects are well described; however, not many dermatological complications have been reported. We present a case of fatal necrotizing fasciitis (NF) secondary to chemotherapy extravasation.CASE PRESENTATION: 55-year-old African American man with anaplastic ALK-negative large T cell lymphoma presented with fatigue, fevers, and palpitations for several weeks. Physical examination was remarkable for tachycardia and tachypnea; he required 4 liters of supplemental oxygen to saturate >90%. Laboratory workup was remarkable for WBC 18.200 m/mm3 and ESR 67 mm/h. CT scan revealed significant mediastinal lymphadenopathy. The symptoms were attributed to the malignancy and CHOP chemotherapy was started. Shortly thereafter, a painful blister at the infusion site was noted. It was deemed to be a local cutaneous vesicant effect from doxorubicin; chemotherapy was stopped and topical dimethyl sulfoxide (DMSO) was applied. No infectious process was identified but the patient continued to be febrile and tachycardic. He developed hypotension hence broadspectrum antibiotics were started. His respiratory status deteriorated and he was intubated. A new subcutaneous tissue induration near the blister rose concern for necrotizing fasciitis (NF) and he was emergently taken to the OR. The fascia was compromised and the biceps muscle was found to be necrotic. He underwent multiple surgical debridements; however, he developed septic shock and died.DISCUSSION: Necrotizing soft tissue infections are a rare but potentially fatal complication of chemotherapy. As vesicants, doxorubicin, and vincristine extravasation is known to result in tissue necrosis. Doxorubicin, an anthracycline, is associated with the highest risk for cutaneous damage. Other risk factors are immunosuppression, obesity, and previous frequent blood draws. DMSO helps with the reabsorption of chemotherapeutics. NF is characterized by rapid fascial destruction with relative skinsparing; accompanied by pain and systemic toxicity. Prompt identification is of paramount importance; however, the diagnosis is challenging as early symptoms tend to be vague. Early surgical debridement and fasciotomy improve survival; broad-spectrum antibiotic coverage and hyperbaric oxygen therapy should be started rapidly as well. Overwhelming sepsis leads to death in more than 70% of the cases.CONCLUSIONS: Chemotherapy extravasation can cause severe skin lesions and death. Initial symptoms may be mild, however, a high degree of suspicion is needed as delays in treatment are associated with poor outcomes.

Background Unlike SARS-CoV and MERS-C0V, SARS-CoV-2 has the potential to become a recurrent seasonal infection; hence, it is essential to compare the clinical spectrum of COVID-19 to the existent endemic coronaviruses. We conducted a retrospective cohort study of hospitalized patients with seasonal coronavirus (sCoV) infection and COVID-19 to compare their clinical characteristics and outcomes. Methods A total of 190 patients hospitalized with any documented respiratory tract infection and a positive respiratory viral panel for sCoV from January 1, 2011, to March 31, 2020, were included. Those patients were compared with 190 hospitalized adult patients with molecularly confirmed symptomatic COVID-19 admitted from March 1, 2020, to May 25, 2020. Results Among 190 patients with sCoV infection, the Human Coronavirus-OC93 was the most common coronavirus with 47.4% of the cases. When comparing demographics and baseline characteristics, both groups were of similar age (sCoV: 74 years vs. COVID-19: 69 years) and presented similar proportions of two or more comorbidities (sCoV: 85.8% vs. COVID-19: 81.6%). More patients with COVID-19 presented with severe disease (78.4% vs. 67.9%), sepsis (36.3% vs. 20.5%), and developed ARDS (15.8% vs. 2.6%) compared to patients with sCoV infection. Patients with COVID-19 had an almost fourfold increased risk of in-hospital death than patients with sCoV infection (OR 3.86, CI 1.99–7.49; p < .001). Conclusion Hospitalized patients with COVID-19 had similar demographics and baseline characteristics to hospitalized patients with sCoV infection; however, patients with COVID-19 presented with higher disease severity, had a higher case-fatality rate, and increased risk of death than patients with sCoV. Clinical findings alone may not help confirm or exclude the diagnosis of COVID-19 during high acute respiratory illness seasons. The respiratory multiplex panel by PCR that includes SARS-CoV-2 in conjunction with local epidemiological data may be a valuable tool to assist clinicians with management decisions.

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