Necrotising fasciitis in chronic lymphocytic leukaemia: a diagnostic challenge, management and learning points

Necrotising soft tissue infection (NSTI), or necrotising fasciitis (NF), is a life-threatening, rapidly spreading bacterial infection affecting soft tissues. Mortality rates can be up to 70%, emphasising the need for early diagnosis and intervention. However, timely identification remains challenging, particularly in immunocompromised patients, due to nonspecific early signs. This case involves a patient who developed NF 12 days after R-CHOP (Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisolone) chemotherapy. Despite clinical and radiological evidence of NF and a high Laboratory Risk Indicator for Necrotising Fasciitis score, blood tests revealed leucopenia, neutropenia and lymphopenia, with no fever and a low National Early Warning Score of one. This atypical presentation underscores the difficulty in diagnosing NF in immunosuppressed individuals. The case highlights the complexity of managing NSTI in such populations, stressing the importance of rapid recognition and treatment to improve outcomes in these high-risk scenarios.