PMC7093746_01
Despite initial broad resection of devitalized skin, fascia, and muscle, areas of ecchymosis and tissue necrosis continued to evolve on the patient's upper back.
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Intra-operatively, necrotizing fasciitis involving her deep dermis and multiple muscle groups was found, requiring extensive debridement and resection of much of the skin, adipose tissue, and fascia of her upper back (Fig. 1).
Healthy wound margins were obtained after a second debridement, and the patient stabilized subsequently.
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Floridly septic, the patient was taken back to the OR the following day for further debridement, and her extensive wounds were left open (Fig. 2); she stabilized subsequently.
Peri-scapular lymph node staining positive (brown) for CD20/CD5 and negative for CD10 and cyclin D, a profile consistent with CLL/small lymphocytic lymphoma.
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Lymph nodes from the patient's back showed architectural effacement by a population of small, mature lymphocytes; immunohistochemistry was consistent with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (Fig. 3).