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Background  Recently, necrotizing fasciitis has been reported in patients treated with bevacizumab, usually secondary to wound healing complications, gastrointestinal perforations, or fistula formation. The risk of invasive  Haemophilus influenzae  type b infection is significantly increased in immunocompromised hosts. However, necrotizing fasciitis due to  Haemophilus influenzae  type b in a patient treated with combined bevacizumab and chemotherapy has not been previously reported.    Case presentation  A 59-year-old woman was admitted to the intensive care unit after sudden onset of fever, chills, and right thigh pain. She received chemotherapy with fluorouracil, irinotecan, and bevacizumab for colon cancer 10 days prior to admission. The advancing erythematous margin and her worsening clinical condition prompted us to suspect necrotizing fasciitis and consult the orthopedics department for a fascia biopsy and debridement. Surgical exploration revealed a murky dishwater-colored pus exudate from the incision site and the lack of a shiny appearance of the fascia that also suggested necrotizing fasciitis. After 2 days, the final results of the blood and exudate cultures confirmed the presence of  Haemophilus influenzae  type b. A diagnosis of necrotizing fasciitis due to  Haemophilus influenzae  type b was made. The patient required recurrent surgical debridement and drainage, but she recovered from the septic shock.    Conclusions  We report a case of necrotizing fasciitis due to  Haemophilus influenzae  type b in a patient without injury and with rectal cancer treated with combined bevacizumab and chemotherapy. Physicians should consider invasive  Haemophilus influenzae  type b disease in the presence of necrotizing fasciitis in patients treated with this combined treatment modality.

bmc infectious diseases

Necrotizing fasciitis caused by Haemophilus influenzae type b in a patient with rectal cancer treated with combined bevacizumab and chemotherapy: a case report