Necrotizing fasciitis secondary to bevacizumab treatment for metastatic rectal adenocarcinoma

Şendur, Mehmet Ali Nahit; Aksoy, Sercan; Özdemir, Nuriye; Zengi̇n, Nurullah

doi:10.4103/0253-7613.125195

Cited by 11 publications

(8 citation statements)

References 8 publications

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“…The majority of the patients described in case reports have had gastrointestinal perforations, fistula formation, or wound healing complications preceding the development of necrotizing fasciitis [6-8]. However, in the present case, the patient had no previous injury or risk factor for necrotizing fasciitis such as a decubitus ulcer, diabetes, or liver cirrhosis; her recent chemotherapy was her primary risk for necrotizing fasciitis.…”

Section: Discussionmentioning

confidence: 68%

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

et al. 2014

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BackgroundRecently, 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 presentationA 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.ConclusionsWe 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.

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Section: Discussionmentioning

confidence: 68%

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

et al. 2014

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“…As regards the temporal relationship between the treatment and side effects, in our patient FG appeared 14 months after lenvatinib was started and was a late serious side effect. In previous reports (15,16,18,19), the median time until the occurrence of this event was 6.5 months (range 4-12) and appeared during treatment with the antiangiogenic agent. In clinical practice, physicians worry about acute side effects, but late side effects could be serious as well and few data are available on this topic (14).…”

Section: Discussionmentioning

confidence: 80%

“…bevacizumab, with death resulting in 13.6% of patients (14). A safety alert regarding some cases related to bevacizumab has also been described in literature (15)(16)(17). Other cases have been reported in association with aflibercept for the treatment of colorectal cancer (18) and sunitinib in a patient treated for renal cell carcinoma (19).…”

Section: Discussionmentioning

confidence: 99%

Fournier's gangrene during lenvatinib treatment: A case report

et al. 2020

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Fournier's gangrene is a rare and severe complication reported in patients with cancer treated with antiangiogenic drugs, most frequently with bevacizumab. The present report describes the case of an 80-year-old man with radioactive iodine-refractory metastatic thyroid cancer treated with lenvatinib (an oral multikinase inhibitor with antiangiogenic properties) who developed Fournier's gangrene in the absence of other known risk factors. To the best of our knowledge, this is the first case described during treatment with lenvatinib. The condition was likely due to a perturbation of vascular endothelial cells of the skin due to the inhibition of VEGF/VEGFR signaling. Fournier's gangrene may be a class effect of antiangiogenic treatment that clinicians should be aware of, as early diagnosis and treatment are associated with an improved outcome.

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“…Temporary interruption of TKIs therapy is recommended for precautionary reasons in patients undergoing major surgical procedures [3]. In 2013, manufacturer of bevacizumab, a monoclonal antibody to the VEGF-A ligand, alerted healthcare professionals to rare cases of necrotizing fasciitis (NF) in patients treated with bevacizumab [[4], [5], [6]]. Recently, NF during sunitinib treatment has been reported in medical literature [7].…”

Section: Introductionmentioning

confidence: 99%