A Nearly Missed Case of Severe Necrotizing Soft Tissue Infection

Necrotizing soft tissue infections (NSTIs) are deadly infections that can involve all tissue layers from the epidermis to the muscle. NSTIs can be difficult to diagnose, as skin manifestations are often absent early in the course of the disease, and they can be difficult to differentiate from simple cellulitis. Definitive diagnosis and treatment occur in the operating room. We present a case of a 65-year-old female who presented with lightheadedness and presyncope, with planned admission for an exacerbation of chronic obstructive pulmonary disease. Prior to admission, however, she was found to have an NSTI. The patient went to the operating room and had an extensive debridement followed by prolonged hospital stay. This case highlights the importance of a thorough physical examination in ill-appearing patients with non-specific symptoms, possible sepsis, and any alteration in mental status.