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Amer et al. J Cancer Metastasis Treat 2018;4:34 I http://dx.doi.org/10.20517/2394-4722.2018.09 Page 3 of 4

prior to admission. It has been documented that chemotherapy leading to alterations on the mucosa, soft-
tissue, and skin along with immunosuppression might be a triggering factor . The skin toxicity (including
[7]
dry skin, erythema, pigmentation, pruritus, rash/desquamation, urticaria, dermatitis, and other) has been
reported in previous studies . It was hypothesized that taxanes metabolites are excreted through the sweat
[8]
glands which are abundant on the palms and soles.

The WHO however, reported in their adverse drug reaction database only 7 cases of necrotizing fasciitis
associated with docetaxel.

To conclude, we should always have a low threshold point in suspecting necrotizing fasciitis when reviewing
patients presenting with pain while on chemotherapy. Also, keeping in mind that patients can appear
systemically well despite the presence of necrotizing fasciitis due to immune suppression - as these patients
are not able to respond to infection adequately and skin manifestation may present different due to their
blunted immunological response system.

DECLARATIONS
Authors’ contributions
Assisted in collection of the data and the patients’ notes from the file, refined the literature and wrote the
paper: Amer NM
Did the primary collection of the patients’ notes, lab results and the photos, collected the literature and
assisted with the writing of the manuscript: Niaz R

Availability of data and materials
All data and information are available from the corresponding author upon request.

Financial support and sponsorship
None.

Conflicts of interest
The authors declare that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable since it is only a case report and not a study.

Consent for publication
Patient gave full informed consent for writing and publishing this paper.

Copyright
© The Author(s) 2018.

REFERENCES
1. Editorial comment. First report of necrotizing fasciitis during concomitant radiotherapy: case report. Reactions 2007;1172:10.
2. Brumann M, Bogner V, Völkl A, Sotlar K, Euler E, Mutschler W. Necrotizing fasciitis in a young patient with acute myeloid leukemia -
a diagnostic challenge. Patient Saf Surg 2014;8:28.
3. Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis 2007;44:705-10.
4. Vijayakumar A, Pullagura R, Thimmappa D. Necrotizing fasciitis: diagnostic challenges and current practices. ISRN Infect Dis
2014;2014:208072.
5. Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (laboratory risk indicator for necrotizing fasciitis) score: a tool for