Necrotising fasciitis after bortezomib and dexamethasone-containing regimen in an elderly patient of Waldenström macroglobulinaemia

BMJ Case Rep. 2014 Mar 26;2014:bcr2013203399. doi: 10.1136/bcr-2013-203399.

Abstract

Bortezomib and high-dose dexamethasone-containing regimens are considered to be generally tolerable with few severe bacterial infections in patients with B-cell malignancies. However, information is limited concerning the safety of the regimen in elderly patients. We report a case of a 76-year-old man with Waldenström macroglobulinaemia who suffered necrotising fasciitis without neutropenia after the combination treatment with bortezomib, high-dose dexamethasone and rituximab. Despite immediate intravenous antimicrobial therapy, he succumbed 23 h after the onset. Physicians should recognise the possibility of fatal bacterial infections related to bortezomib plus high-dose dexamethasone in elderly patients, and we believe this case warrants further investigation.

Publication types

  • Case Reports

MeSH terms

  • Age Factors
  • Aged
  • Antibodies, Monoclonal, Murine-Derived / administration & dosage
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Agents, Hormonal / administration & dosage
  • Antineoplastic Agents, Hormonal / adverse effects*
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Boronic Acids / administration & dosage
  • Boronic Acids / adverse effects*
  • Boronic Acids / therapeutic use
  • Bortezomib
  • Dexamethasone / administration & dosage
  • Dexamethasone / adverse effects*
  • Dexamethasone / therapeutic use
  • Drug Therapy, Combination
  • Fasciitis, Necrotizing / diagnosis
  • Fasciitis, Necrotizing / etiology*
  • Fatal Outcome
  • Humans
  • Klebsiella Infections / diagnosis
  • Klebsiella Infections / etiology*
  • Klebsiella pneumoniae
  • Male
  • Pyrazines / administration & dosage
  • Pyrazines / adverse effects*
  • Pyrazines / therapeutic use
  • Rituximab
  • Waldenstrom Macroglobulinemia / drug therapy*

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Antineoplastic Agents
  • Antineoplastic Agents, Hormonal
  • Boronic Acids
  • Pyrazines
  • Rituximab
  • Bortezomib
  • Dexamethasone