A 65-yr women presented in 12/2018 with fecal OB+ and anemia. Endoscopy showed esophageal-gastric body invasive lesion. Biopsy verified low differentiate carcinoma, Her-2(0). PET-CT showed multiple lymph nodes,mesenteric, omental metastasis. She was treated with chemotherapy(paclitaxel+S1). During the chemo,red plaques like rash appeared on hands and face.Dermatologist considered dermatitis medicamentosa and treated with Tacrolimus.The rash subsided but leaved the pigmentation.The efficacy of chemo reached PR.On 23/8/2019,she received laparoscopic exploration and radical total gastrectomy(ypT4aN3M0,IIIC). In 3/2020,CT scan showed double pyeloectasis and low biliarty obstruction caused by recurrent peritoneal metastasis. After the pyelostomy and PTCD,her renal and liver function recovered.MFOLFOX7 was tried to control the tumor progression. However,ascites appeared and some adenocarcinoma cells were found among exfoliated cells of the ascites.
On 16/5/2020, after the drainage of ascites, 60mg paclitaxel was treated as intraperitoneal infusion chemotherapy. On 17/5/2020, red plague rashes appeared at hands and feet. A day later,blisters appeared and extremities of limbs turned to blackened.Besides skin change, the patient had hypotension,fever and diarrhea. Dermatologist diagnosed it as fixed drug eruption since the history of dermatitis medicamentosa. Glucocorticoids for external and intravenous use was recommended. However the lesion of the skin continued to progressed fast. The gangrene of the extremities was worsen on 19/5/2020. The limb doppler US did not discovered any thrombus at main arteries. The second dermatological consultation diagnosis was necrotizing fasciitis.Moreover PCT evaluated >200ng/ml，CRP was 166ng/L. Blood cell decreased thoroughly,which indicated hemophagocytic syndrome caused by serious infection. Since the patient suffered the septicopyemia combined with metastatic gastric cancer, prognosis was poor. Intensive therapy was given up. On 20/5/2020, the patient passed away. After her death,the bacterial culture of the blister fluid abtained when she was alive, came out to be the aeromonas hydrophil,which may cause the necrotizing fasciitis.