Necrotizing fasciitis and acute kidney injury in a patient with acute myelogenous leukemia—case presentation and review of the literature

Abstract

Introduction: Necrotizing fasciitis is characterized by fulminant destruction of soft tissue. Patients present with signs of systemic inflammation as well as local tense edema along with bullae and subcutaneous gas. Case presentation: A 46 year-old male was transferred to our tertiary-care center with a necrotizing fasciitis of the right forearm and acute kidney injury. To find causative pathogens/conditions of the necrotizing fasciitis microbiological, viral tests as well as immunological parameters (ANCA, ANA, cryoglobulines, anti-SM antibodies) were analyzed, but were all negative. A kidney biopsy revealed a non-putride interstitial nephritis. Despite adequate surgical therapy of the fasciitis and empiric antibiotic therapy, the patient's condition did not improve significantly. He developed fever up to 39 degrees Celsius while being under continued antibiotic therapy. A progressive increase of the white blood cell count was observed with predominance of monocytes (44%). A bone marrow biopsy showed an acute myelogenous leukaemia. With successful treatment of the leukaemia, the patient recovered from his fasciitis. Conclusion: Necrotizing fasciitis in patients with leukemia has been occasionally reported, relating the fasciitis to an infection in the immunocompromised condition. Our case is most likely the first reported case of true paraneoplastic fasciitis in leukemia because all other potential causes including infection were negative. Response to Reviewers: We thank the reviewer for his/her valuable comments. The title was changed according to the suggestion of the reviewer. In addition, we shortened the manuscript by 30% as suggested by the editor. pe er -0 05 54 99 2, v er si on 1 12 J an 2 01 1 Author manuscript, published in "Annals of Hematology 90, 2 (2010) 235-238" DOI : 10.1007/s00277-010-0995-0