{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T23:01:02Z","timestamp":1769814062363,"version":"3.49.0"},"reference-count":19,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,1,6]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2025-268411","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:25:18Z","timestamp":1769772318000},"page":"e268411","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Necrotising fasciitis in chronic lymphocytic leukaemia: a diagnostic challenge, management and learning points"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6827-3871","authenticated-orcid":false,"given":"Arthur Chen Wun","family":"Tan","sequence":"first","affiliation":[{"name":"Orthopaedic Surgery, University Hospitals Sussex NHS Foundation Trust, Brighton, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eun Young","family":"Han","sequence":"additional","affiliation":[{"name":"Medicine\/Haematology, University Hospitals Sussex NHS Foundation Trust, Brighton, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ezanul","family":"Harriz Abd Wahab","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, University Hospitals Sussex NHS Foundation Trust, Brighton, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Chevassut","sequence":"additional","affiliation":[{"name":"Haematology, University Hospitals Sussex NHS Foundation Trust, Brighton, England, UK"},{"name":"Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026013003251269000_19.1.e268411.1","first-page":"363","article-title":"Necrotising fasciitis in the North East of Scotland: a 10-year retrospective review","volume":"101","author":"Neilly","year":"2019","journal-title":"Ann R Coll Physicians Surg Can"},{"key":"2026013003251269000_19.1.e268411.2","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.12968\/jowc.2018.27.Sup9a.S20","article-title":"Managing necrotising fasciitis to reduce mortality and increase limb salvage","volume":"27","author":"Kim","year":"2018","journal-title":"J Wound Care"},{"key":"2026013003251269000_19.1.e268411.3","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000129486.35458.7D"},{"key":"2026013003251269000_19.1.e268411.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.anaerobe.2017.07.008"},{"key":"2026013003251269000_19.1.e268411.5","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1177\/229255030401200305","article-title":"Necrotizing fasciitis: Diagnosis and management of an occult infective focus","volume":"12","author":"Chandawarkar","year":"2004","journal-title":"Can J Plast Surg"},{"key":"2026013003251269000_19.1.e268411.6","doi-asserted-by":"crossref","unstructured":"Foo RM , Tung ML , Poon LM , et al . Necrotizing Fasciitis in Hematological Patients: Enterobacteriaceae Predominance and Limited Utility of Laboratory Risk Indicator for Necrotizing Fasciitis Score. Open Forum Infect Dis 2015;2. doi:10.1093\/ofid\/ofv081","DOI":"10.1093\/ofid\/ofv081"},{"key":"2026013003251269000_19.1.e268411.7","doi-asserted-by":"crossref","first-page":"2393","DOI":"10.1007\/s00268-019-05061-4","article-title":"The SIARI Score: A Novel Decision Support Tool Outperforms LRINEC Score in Necrotizing Fasciitis","volume":"43","author":"Cribb","year":"2019","journal-title":"World j Surg"},{"key":"2026013003251269000_19.1.e268411.8","first-page":"981","article-title":"Necrotizing fasciitis","volume":"55","author":"Puvanendran","year":"2009","journal-title":"Can Fam Physician"},{"key":"2026013003251269000_19.1.e268411.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.330.7495.830"},{"key":"2026013003251269000_19.1.e268411.10","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.1016\/j.injury.2007.10.030","article-title":"Necrotising fasciitis of upper and lower limb: A systematic review","volume":"38","author":"Angoules","year":"2007","journal-title":"Injury"},{"key":"2026013003251269000_19.1.e268411.11","doi-asserted-by":"publisher","DOI":"10.1067\/j.cpsurg.2014.06.001"},{"key":"2026013003251269000_19.1.e268411.12","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1128\/br.26.2_pt_1-2.177-274.1962","article-title":"The histotoxic clostridial infections of man","volume":"26","author":"MACLENNAN","year":"1962","journal-title":"Bacteriol Rev"},{"key":"2026013003251269000_19.1.e268411.13","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1080\/08998280.2014.11929074","article-title":"Fatal Clostridium Septicum Infection in a Patient with a Hematological Malignancy","volume":"27","author":"Ragesh","year":"2014","journal-title":"Baylor Univ Med Cent Proc"},{"key":"2026013003251269000_19.1.e268411.14","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s11899-017-0366-1","article-title":"A Concise Review of Autoimmune Cytopenias in Chronic Lymphocytic Leukemia","volume":"12","author":"Tsang","year":"2017","journal-title":"Curr Hematol Malig Rep"},{"key":"2026013003251269000_19.1.e268411.15","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2015-03-567388"},{"key":"2026013003251269000_19.1.e268411.16","first-page":"1","article-title":"A Case of Rituximab-Induced Necrotizing Fasciitis and a Review of the Literature","volume":"2017","author":"Abdulkareem","year":"2017","journal-title":"Case Rep Hematol"},{"key":"2026013003251269000_19.1.e268411.17","doi-asserted-by":"crossref","DOI":"10.1186\/1741-7015-9-36","article-title":"Risk of infection in patients with lymphoma receiving rituximab: systematic review and meta-analysis","volume":"9","author":"Lanini","year":"2011","journal-title":"BMC Med"},{"key":"2026013003251269000_19.1.e268411.18","first-page":"245","article-title":"Necrotizing fasciitis","volume":"12","author":"Davoudian","year":"2012","journal-title":"CEACCP"},{"key":"2026013003251269000_19.1.e268411.19","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jfma.2019.01.014","article-title":"Predisposing factors of necrotizing fasciitis with comparison to cellulitis in Taiwan: A nationwide population-based case\u2013control study","volume":"119","author":"Liu","year":"2020","journal-title":"J Formos Med Assoc"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-268411","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:25:20Z","timestamp":1769772320000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-268411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,30]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bcr-2025-268411"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-268411","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}