Necrotizing Fasciitis in a Patient with Metastatic Clear Cell Ovarian Carcinoma Treated with Bevacizumab

Patient: Female, 58-year-old Final Diagnosis: Necrotizing fasciitis Symptoms: Pain and swelling in the right gluteal region Medication: — Clinical Procedure: — Specialty: Critical Care Medicine • General and Internal Medicine • Oncology OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: Necrotizing fasciitis is a life-threatening infection of the deep soft tissues that leads to progressive destruction of the fascia and subcutaneous fat. It typically spreads along the muscle fascia planes because of the relatively poor blood supply. Muscle tissue is usually spared because of its better blood supply. The usual risk factors for necrotizing fasciitis include trauma, malnutrition, obesity, uncontrolled diabetes mellitus, alcoholism, cirrhosis, neutropenia, and recent surgery. CASE REPORT: We discuss a case of a middle-aged woman who presented with necrotizing fasciitis of the right gluteal region. Her medical comorbidities included diabetes mellitus (well-controlled, hemoglobin A1c: 6.6), and clear cell carcinoma of ovaries (stage IV). She was on active chemotherapy with bevacizumab, paclitaxel, and carboplatin. She underwent incision and debridement of the right gluteal abscess, with drainage of 200 mL of foul-smelling pus, and was started on intravenous antibiotics. Blood culture results were negative, but the cultures taken from the right gluteal abscess showed moderate growth of Escherichia coli. The antibiotics were de-escalated, and the patient was discharged with plans for outpatient follow-up. CONCLUSIONS: Bevacizumab, a humanized monoclonal IgG antibody, is a new treatment for metastatic ovarian carcinoma. It is associated with necrotizing fasciitis due to antiangiogenic, prothrombotic, and poor wound healing properties. Bevacizumab should be stopped in patients presenting with necrotizing fasciitis.