title: Necrotizing fasciitis caused by Haemophilus influenzae type b in a patient with rectal cancer treated with combined bevacizumab and chemotherapy: a case report.
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.
  
  
  METHODS
  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.
authors.affiliation: Division of General Internal Medicine and Infectious Disease, Department of Medicine, Kameda Medical Center, Kamogawa-shi, Chiba 296-8601, Japan. harukakanata58@yahoo.co.jp.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Ugai
authors.forename: Masataro
authors.initials: M
authors.lastname: Norizuki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Mikawa
authors.forename: Goh
authors.initials: G
authors.lastname: Ohji
authors.forename: Makito
authors.initials: M
authors.lastname: Yaegashi
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab; D019115:Fasciitis, Necrotizing / Q000821:virology*; D005260:Female; D006192:Haemophilus Infections / Q000821:virology*; D019741:Haemophilus influenzae type b / Q000302:isolation & purification*; D006801:Humans; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000821:virology*; D012772:Shock, Septic / Q000821:virology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab
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