A Case of Rituximab-Induced Necrotizing Fasciitis and a Review of the Literature

Table 1

Cases of patients developing NF after rituximab therapy.

S/N	Study	Condition	Age/sex	Dosing protocol	Cycle,; dose	Onset of NF from last dose	Organism	Location; of NF	Concurrent; medication	Comorbidities	Outcome
1	Current study	CLL	69/M	375 mg/m^2 ×4	2, 4	7 weeks	Clostridium septicum	LLE	None	None	Survived
2	Lazzeri et al. [9, 10]	CLL	44/M	NA	NA	NA	Pseudomonas aeruginosa	Periorbital	Fludarabine; Cyclophosphamide	NA	Survived
3	Guerrero et al. [11]; Wong et al. [12]	SLE	21/M	NA	NA	NA	Acinetobacter baumannii	Abdomen; Bil flanks; Thigh; Scapula	Steroids	NA	Died
4	Krieger et al. [13]	NHL, follicular	48/F	375 mg/m^2; (weekly)	1, 4	1 month	Pseudomonas aeruginosa	Left lower; extremity	NA	NA	Died
5	Krieger et al. [13]	NHL, follicular	59/M	375 mg/m^2 (weekly); Rituximab stopped after 3 doses.	1, 3	NA	Escherichia coli (E. coli)	Scrotum	Etoposide, cisplatin, methyl prednisone, cytosine, and arabinoside	NA	Died
6	Looney et al. [14]	SLE	37/F	375 mg/m^2 ×4; (weekly)	1, 4	6 weeks	Group A Streptococcus	Elbow	Methotrexate; Steroids	Septic arthritis	N/A
7	Chen and Isenberg [15]	SLE	26/F	1 g weekly	1, 2	2 months	Pseudomonas aeroginosa	LLE	Hydroxychloroquine; Azathioprine; Cyclophosphamide; Steroid	AVN below; Digital ischemia; E. coli UTI	Survived
8	Morita et al. [16]	Waldenstrom’s macroglobulinemia	76/M	375 mg/m^2; (weekly)	1, 1	2 weeks	Klebsiella pneumonia	RLE	Bortezomib; Dexamethasone	Diarrhea	Died
9	Raghuvanshi and Menon [17]	Rheumatoid arthritis	62/F	NA	1, 2	2 weeks	Group A Streptococcus	LUE	Prednisone	NA	Died

AVN = avascular necrosis; Bil = bilateral; CLL = chronic lymphocytic leukemia; F = female; LLE = left lower extremity; LUE = left upper extremity; M = male; NA = not available; NF = necrotizing fasciitis; NHL = non-Hodgkin’s lymphoma; RLE = right lower extremity; SLE = systemic lupus erythematosus; S/N = serial number; UTI = urinary tract infection.