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A Case of Rituximab-Induced Necrotizing Fasciitis and a Review of the Literature. Case Rep Hematol 2017; 2017:6971027. [PMID: 29082050 PMCID: PMC5634570 DOI: 10.1155/2017/6971027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/22/2017] [Indexed: 11/25/2022] Open
Abstract
Necrotizing fasciitis is a fulminant soft tissue infection characterized by rapid progression and high mortality. Rituximab is a generally well-tolerated immunosuppresive medication used for B-cell malignancies and some rheumatological disorders. We report a case of a 69-year-old male with chronic lymphocytic leukemia who suffered necrotizing fasciitis of his left lower extremity secondary to Clostridium septicum 7 weeks after treatment with rituximab. Despite immediate intravenous antimicrobial therapy and emergent fasciotomy with extensive debridement, his hospital course was complicated by septic shock and he required an above-the-knee amputation. Physicians need to be aware of the possibility of necrotizing fasciitis in patients presenting with skin infections after rituximab therapy.
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Morita T, Ugai T, Tanimoto T, Matsue K. Necrotising fasciitis after bortezomib and dexamethasone-containing regimen in an elderly patient of Waldenström macroglobulinaemia. BMJ Case Rep 2014; 2014:bcr-2013-203399. [PMID: 24671324 DOI: 10.1136/bcr-2013-203399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Bortezomib and high-dose dexamethasone-containing regimens are considered to be generally tolerable with few severe bacterial infections in patients with B-cell malignancies. However, information is limited concerning the safety of the regimen in elderly patients. We report a case of a 76-year-old man with Waldenström macroglobulinaemia who suffered necrotising fasciitis without neutropenia after the combination treatment with bortezomib, high-dose dexamethasone and rituximab. Despite immediate intravenous antimicrobial therapy, he succumbed 23 h after the onset. Physicians should recognise the possibility of fatal bacterial infections related to bortezomib plus high-dose dexamethasone in elderly patients, and we believe this case warrants further investigation.
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Geyer JT, Niesvizky R, Jayabalan DS, Mathew S, Subramaniyam S, Geyer AI, Orazi A, Ely SA. IgG4 plasma cell myeloma: new insights into the pathogenesis of IgG4-related disease. Mod Pathol 2014; 27:375-81. [PMID: 24030741 DOI: 10.1038/modpathol.2013.159] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/09/2013] [Accepted: 07/14/2013] [Indexed: 12/24/2022]
Abstract
IgG4-related disease is a newly described systemic fibroinflammatory process, characterized by increase in IgG4-positive plasma cells. Its pathogenesis, including the role of IgG4, remains poorly understood. Plasma cell myeloma is typically associated with a large monoclonal serum spike, which is frequently of IgG isotype. We sought to identify and characterize a subset of IgG4-secreting myeloma, as it may provide a biological model of disease with high serum levels of IgG4. Six out of 158 bone marrow biopsies (4%) from patients with IgG myeloma expressed IgG4. Four patients were men and two were women, with a mean age of 64 (range 53-87) years. Imaging showed fullness of pancreatic head (1), small non-metabolic lymphadenopathy (1), and bone lytic lesions (6). Two patients developed necrotizing fasciitis. All had elevated serum M-protein (mean 2.4, range 0.5-4.2 g/dl), and none had definite signs or symptoms of IgG4-related disease. Four myelomas had plasmablastic morphology. Four had kappa and two had lambda light chain expression. Three cases expressed CD56. Two patients had a complex karyotype. In conclusion, the frequency of IgG4 myeloma correlates with the normal distribution of IgG4 isoform. The patients with IgG4 myeloma appear to have a high rate of plasmablastic morphology and could be predisposed to necrotizing fasciitis. Despite high serum levels of IgG4, none had evidence of IgG4-related disease. These findings suggest that the increased number of IgG4-positive plasma cells is not the primary etiologic agent in IgG4-related disease. Elevated serum levels of IgG4 is not sufficient to produce the typical disease presentation and should not be considered diagnostic of IgG4-related disease.
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Affiliation(s)
- Julia T Geyer
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Ruben Niesvizky
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - David S Jayabalan
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Susan Mathew
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Shivakumar Subramaniyam
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Alexander I Geyer
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Scott A Ely
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
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Munoz J, Namo S, Stoltenberg M, Chapman R. Salmonella-related mycotic aortic aneurysm heralding a diagnosis of multiple myeloma. Am J Hematol 2012; 87:820-1. [PMID: 22473926 DOI: 10.1002/ajh.23183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 02/23/2012] [Accepted: 02/27/2012] [Indexed: 11/05/2022]
Affiliation(s)
- Javier Munoz
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan 48202, USA.
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Sultan S, Morawa E, Niesvizky R, Talmor M, Barie PS. Necrotizing Soft Tissue Infection in Two Patients with Multiple Myeloma. Surg Infect (Larchmt) 2011; 12:391-5. [DOI: 10.1089/sur.2010.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Samuel Sultan
- Department of Surgery, Weill Cornell Medical College, New York, New York
| | - Ewelina Morawa
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ruben Niesvizky
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mia Talmor
- Department of Surgery, Weill Cornell Medical College, New York, New York
| | - Philip S. Barie
- Department of Surgery, Weill Cornell Medical College, New York, New York
- Department of Public Health, Weill Cornell Medical College, New York, New York
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