Unsuspected early necrotizing fasciitis identified by 18F-FDG PET imaging in a patient with acute myeloid leukemia

Document Type : Case Report


Department of Nuclear Medicine & PET/CT, Amrita Institute of Medical Sciences, Cochin, Kerala, India


Necrotizing fasciitis is a part of a spectrum of necrotizing soft tissue infections that usually follow a surgical intervention or a chronic / acute medical illness. Diagnosis is often based on symptoms which classically start within hours after an injury. There are no reports on the use of PET/CT in this condition. Sparing reports of its association in patients with malignancy (Ca of colon and rectum) are available. Here we present a young lady in remission from acute myeloid leukemia (AML) with sudden onset right knee pain and fever after a trivial foot injury. Clinically an osteomyelitis or acute septic arthritis was suspected, although the location is not appropriate for osteomyelitis. 99mTc-MDP bone scan was performed followed by 18F-FDG PET. 18F-FDG PET scan was incremental in diagnosing subcutaneous infection around right knee even before appearance of an ulcer or skin erosion. Tissue culture confirmed necrotizing fasciitis. This is the first case report highlighting necrotizing fasciitis in a patient with AML.


Main Subjects

Wilson B. Necrotizing fasciitis. Am Surg. 1952 Apr;18(4):416-31.
Namias N, Martin L, Matos L, Sleeman D, Snowden B. Symposium: Necrotizing fasciitis. Contemp Surg. 1996;49(3):167-178.
Lille ST, Sato TT, Engrav LH, Foy H, Jurkovich GJ. Necrotizing soft tissue infections: obstacles in diagnosis. J Am Coll Surg. 1996 Jan;182(1):7-11.
Kim HJ, Kim DH, Ko DH. Coagulase-positive staphylococcal necrotizing fasciitis subsequent to shoulder sprain in a healthy woman. Clin Orthop Surg. 2010 Dec;2(4):256-9.
Light TD, Choi KC, Thomsen TA, Skeete DA, Latenser BA, Born JM, Lewis RW 2nd, Wibbenmeyer LA, Shyamalkumar ND, Lynch CF, Kealey GP. Long-term outcomes of patients with necrotizing fasciitis. J Burn Care Res. 2010 Jan-Feb;31(1):93-9.
Sharif HS, Clark DC, Aabed MY, Aideyan OA, Haddad MC, Mattsson TA.  MR imaging of thoracic and abdominal wall infections: comparison with other imaging procedures. AJR Am J Roentgenol. 1990 May;154(5):989-95.
Duncan BW, Adzick NS, deLorimier AA, Longaker MT, Ferrell LD, Zoger S, Harrison MR. Necrotizing fasciitis in two children with acute lymphoblastic leukemia. J Pediatr Surg. 1992 May;27(5):668-71.
Lou J, Low CH. Necrotising fasciitis in leukaemic children. Ann Acad Med Singapore. 1990 Mar;19(2):290-4.