Necrotizing fasciitis following targeted therapy in a patient with unresectable hepatocellular carcinoma: A case report

Abstract

Here, we report a rare and clinically significant case of a 70-year-old man with unresectable hepatocellular carcinoma arising in the setting hepatitis B-related cirrhosis. After the failure of transarterial chemoembolization, the patient was switched to systemic therapy with atezolizumab and bevacizumab. After completing the 11th treatment cycle, the patient developed a high-grade fever, followed 5 days later by progressive pain radiating from the left buttock to the thigh. Laboratory tests revealed markedly elevated inflammatory markers, and contrast-enhanced computed tomography showed ill-defined low-density areas with fascial enhancement, findings consistent with necrotizing fasciitis. Prompt treatment with intravenous cefazolin and surgical drainage resulted in gradual clinical improvement. Streptococcus dysgalactiae was identified in the abscess fluid culture. This case highlights that severe soft tissue infections such as necrotizing fasciitis can occur as rare but serious adverse events during bevacizumab therapy, possibly related to impaired wound healing and tissue perfusion caused by vascular endothelial growth factor inhibition.