CATASTROPHIC COMPLICATIONS OF CHEMOTHERAPY EXTRAVASATION

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Chemotherapy is the mainstay of cancer treatment. Hematological side effects are well described; however, not many dermatological complications have been reported. We present a case fatal necrotizing fasciitis (NF) secondary to chemotherapy extravasation. CASE PRESENTATION: 55-year-old African American man with anaplastic ALK-negative large T cell lymphoma presented fatigue, fevers, and palpitations for several weeks. Physical examination was remarkable tachycardia tachypnea; he required 4 liters supplemental oxygen saturate >90%. Laboratory workup WBC 18.200 m/mm3 ESR 67 mm/h. CT scan revealed significant mediastinal lymphadenopathy. The symptoms were attributed malignancy CHOP started. Shortly thereafter, painful blister at infusion site noted. It deemed be local cutaneous vesicant effect from doxorubicin; stopped topical dimethyl sulfoxide (DMSO) applied. No infectious process identified but patient continued febrile tachycardic. He developed hypotension hence broad-spectrum antibiotics His respiratory status deteriorated intubated. A new subcutaneous tissue induration near rose concern emergently taken OR. fascia compromised biceps muscle found necrotic. underwent multiple surgical debridements; septic shock died. DISCUSSION: Necrotizing soft infections rare potentially complication chemotherapy. As vesicants, doxorubicin, vincristine extravasation known result in necrosis. Doxorubicin, an anthracycline, associated highest risk damage. Other factors immunosuppression, obesity, previous frequent blood draws. DMSO helps reabsorption chemotherapeutics. NF characterized by rapid fascial destruction relative skin-sparing; accompanied pain systemic toxicity. Prompt identification paramount importance; diagnosis challenging as early tend vague. Early debridement fasciotomy improve survival; antibiotic coverage hyperbaric therapy should started rapidly well. Overwhelming sepsis leads death more than 70% cases. CONCLUSIONS: can cause severe skin lesions death. Initial may mild, high degree suspicion needed delays treatment poor outcomes. REFERENCE #1: Kreidieh FY, Moukadem HA, El Saghir NS. Overview, prevention management World J Clin Oncol. 2016;7(1):87-97. doi:10.5306/wjco.v7.i1.87 DISCLOSURES: relevant relationships Daniel Bustamante-Soliz, source=Web Response Dennis Kumi, Valeria Trelles Garcia, Catherine Weir,