Spontaneous gaseous necrotizing myofasciitis in a patient with B-cell lymphoma status-post induction chemotherapy

A 50-year-old female with diffuse large B-cell lymphoma and recent completion of chemotherapy with Pola-R-CHP presented to the emergency department with right lower extremity weakness and pain, hypotension, tachycardia, and altered mental status, along with tense, edematous, and pulseless compartments of the right lower extremity. The patient was taken emergently to the operating room with trauma and orthopedic surgery and found to have a severe necrotizing infection involving the muscles of the right lower extremity, ascending to the retroperitoneum, involving the right iliacus muscle, right iliopsoas, and ascending colon. At that time, she underwent a right transfemoral amputation, a right hemicolectomy, and was left in discontinuity to stabilize her in the ICU until returning the next day. NSTIs (necrotizing soft tissue infection) are rare but rapidly progressive, life-threatening infections. This case report highlights the importance of early and aggressive surgical intervention to improve the survival of patients with NSTIs.