ABSTRACT Necrotising fasciitis is a rare rapidly progressive, life threatening, soft tissue infection which spreads along fascial planes. We present a patient who was diagnosed with a primary cutaneous Diffuse Large B-Cell Lymphoma (leg type) following initial presentation as probable necrotising fasciitis. Presentation was of a painful swollen leg, septic shock and MRI findings consistent with the clinical signs. Diagnosis of necrotising fasciitis remains challenging and it is often missed in the early stages. Early fascial biopsy and histopathological analysis is useful in cases where the diagnosis is unclear. We feel that this case highlights these important issues and will benefit others in their management of similar cases in the future.
Cite this paper
N. M. McInerney, K. T. Power and A. J. Hussey, "Primary Cutaneous Diffuse Large B-Cell Lymphoma (Leg Type) Presenting as Necrotising Fasciitis," Modern Plastic Surgery, Vol. 2 No. 4, 2012, pp. 99-102. doi: 10.4236/mps.2012.24024.
 E. J. Whallett, J. H. Stevenson and A. D.Wilmshurst, “Necrotising Fasciitis of the Extremity,” Journal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 63, No. 5, 2010, pp. e469-e473. doi:10.1016/j.bjps.2009.09.011
 R. Kaul, A. McGeer, D. E. Low, et al., “Population-Based Surveillance for Group a Streptococcal Necrotizing Fasciitis: Clinical Features, Prognostic Indicators, and Microbiologic Analysis of Seventy-Seven Cases. Ontario Group A Streptococcal Study,” American Journal of Medicine, Vol. 103, No. 1, 1997, pp. 18-24.
 D. A. Anaya and E. P. Dellinger, “Necrotizing Soft-Tissue Infection: Diagnosis and Management,” Clinical Infectious Diseases, Vol. 44, No. 5, 2007, pp. 705-710.
 B. J. Childers, L. D. Potyondy, R. Nachreiner, et al., “Necrotizing Fasciitis: A Fourteen-Year Retrospective Study of 163 Consecutive Patients,” The American Journal of Surgery, Vol. 68, No. 2, 2002, pp. 109-116.
 A. Rahmouni, O. Chosidow, D. Mathieu, et al., “MR Imaging in Acute Infectious Cellulites,” Radiology, Vol. 192, No. 2, 1994, pp. 493-496.
 J. D. Urschel, “Necrotizing Soft Tissue Infections,” Postgraduate Medical Journal, Vol. 75, No. 889, 1999, pp. 645-649. doi:10.1136/pgmj.75.889.645
 C. H. Wong, A. K. Yam, A. B. Tan, et al., “Approach to Debridement in Necrotizing Fasciitis,” The American Journal of Surgery, Vol. 196, No. 3, 2008, pp. e19-e24.
 I. Stamenkovic and P. D. Lew, “Early Recognition of Potentially Fatal Necrotizing Fasciitis. The Use of Frozen-Section Biopsy,” The New England Journal of Medicine, Vol. 310, No. 26, 1984, pp. 1689-1693.
 J. Majeski and E. Majeski, “Necrotizing Fasciitis: Improved Survival with Early Recognition by Tissue Biopsy and Aggressive Surgical Treatment,” Southern Medical Journal, Vol. 90, No. 11, 1997, pp. 1065-1068.
 R. Willemze, H. Kerl, W. Sterry, et al., “EORTC Classification for Primary Cutaneous Lymphomas: A Proposal from the Cutaneous Lymphoma Study Group of the European Organization for Research and Treatment of Cancer,” Blood, Vol. 90, No. 1, 1997, pp. 354-371.
 P. Isaacson and A. Norton, “Cutaneous lymphomas,” In: P. G. Isaacson and N. A. Wright, Eds., Extranodal Lymphomas, Churchill Livingstone, London, 1994, p. 172.
 F. A. Geelen, M. H. Vermeer, C. J. Meijer, et al., “Bcl-2 Protein Expression in Primary Cutaneous Large B-Cell Lymphoma is Site-Related,” Journal of Clinical Oncology, Vol. 16, No. 6, 1998, pp. 2080-2085.
 F. Grange, M. W. Bekkenk, J. Wechsler, et al., “Prognostic Factors in Primary Cutaneous Large B-Cell Lymphomas: A European Multicenter Study,” Journal of Clinical Oncology, Vol. 19, No. 16, 2001, pp. 3602-3610.
 F. Grange, M. Beylot-Barry, P. Courville, et al., “Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type: Clinicopathologic Features and Prognostic Analysis in 60 Cases,” Archives of Dermatology, Vol. 143, No. 9, 2007, pp. 1144-1150. doi:10.1001/archderm.143.9.1144
 R. Willemze, E. S. Jaffe, G. Burg, et al., “WHO-EORTC Classification for Cutaneous Lymphomas,” Blood, Vol. 105, No. 10, 2005, pp. 3768-3785.
 P. L. Zinzani, P. Quaglino, N. Pimpinelli, et al., “Prognostic Factors in Primary Cutaneous B-Cell Lymphoma: the Italian Study Group for Cutaneous Lymphomas,” Journal of Clinical Oncology, Vol. 24, no. 9, 2006, pp. 1376-1382. doi:10.1200/JCO.2005.03.6285
 N. J. Senff, E. M. Noordijk, Y. H. Kim, et al., “European Organization for Research and Treatment of Cancer and International Society for Cutaneous Lymphoma Consensus Recommendations for the Management of Cutaneous B-Cell Lymphomas,” Blood, Vol. 112, No. 5, 2008, pp. 1600-1609. doi:10.1182/blood-2008-04-152850
 B. Dreno, “Standard and New Treatments in Cutaneous B-Cell Lymphomas,” Journal of Cutaneous Pathology, Vol. 33, No. S1, 2006, pp. 47-51.
 P. Golling, A. Cozzio, R. Dummer, et al., “Primary Cutaneous B-Cell Lymphomas—Clinicopathological, Prognostic and Therapeutic Characterisation of 54 Cases according to the WHO-EORTC Classification and the ISCL/EORTC TNM Classification System for Primary Cutaneous Lymphomas Other than Mycosis Fungoides and Sezary Syndrome,” Leuk Lymphoma, Vol. 49, No. 6, 2008, pp. 1094-1103. doi:10.1080/10428190802064925