Successful VA ECMO on an adolescent pre-B cell acute lymphoblastic leukemia patient with necrotizing fasciitis from Clostridium septicum

Abstract

Extracorporeal membrane oxygenation (ECMO) has historically been avoided in oncological patients due to perceived risks. However, recent literature suggests improved survival rates for pediatric oncology patients. Additionally, necrotizing fasciitis from Clostridium septicum is associated with high morbidity and mortality, especially in patients with preexisting malignancies. Few studies have explored the outcomes of ECMO in patients with both necrotizing fasciitis and hematologic malignancies. We present a case of a 16-year-old male with pre-B cell acute lymphoblastic leukemia (ALL) and Clostridium septicum necrotizing fasciitis successfully supported with veno-arterial (VA) ECMO. The patient underwent induction chemotherapy for ALL but developed severe septic shock and necrotizing fasciitis. The patient was deemed an ECMO candidate based on the favorable prognosis of both ALL and necrotizing fasciitis. He underwent ECPR and was cannulated onto VA ECMO. Surgical interventions were performed while on ECMO, including debridement and abdominal wound management. Despite complications such as gastrointestinal bleeding, the patient was successfully decannulated from ECMO after eight days. He recovered well, with no recurrence of bleeding, resumed chemotherapy, and was discharged home on day 54. Follow-up appointments showed remission from ALL and good functional recovery. This case highlights the feasibility and success of ECMO support in an adolescent with both ALL and necrotizing fasciitis. Careful patient selection, multidisciplinary collaboration, and aggressive management of complications are crucial for favorable outcomes in such complex cases. ECMO candidacy should be considered on an individual basis, even in patients with high-risk surgical interventions.

Keywords: Acute Lymphoblastic Leukemia; Clostridium septicum; Extracorporeal support; necrotizing fasciitis.

Fig. 1

Abdominal computed tomography: A. Axial view computed tomography of abdomen showing foci of free air; B. Sagittal view computed tomography of abdomen showing foci of free air.