Synchronous multifocal necrotizing soft tissue infections: a case report and literature review

Kin Seng Tong, Daniel C. Williams, Marc A. Seifman, David J. Hunter-Smith, Warren Matthew Rozen

Research output: Contribution to journalArticleOtherpeer-review


Necrotizing soft tissue infections are a group of conditions with a common pathophysiological basis, affecting any or all layers of the soft tissue compartment. They are rare, life-threatening diseases that require a high index of suspicion for early detection as well as urgent surgical debridement. Rarely, they can occur in more than one non-contiguous site of the body (‘multifocal’ disease), and this is associated with a much higher mortality than monofocal disease. Here, we present the case of a 46-year-old male with bilateral upper limb necrotizing soft tissue infection following an unclear history of trauma. The patient developed septic shock necessitating transfer to the intensive care unit following emergency surgery. Microbiological tests yielded Streptococcus pyogenes, Staphylococcus aureus and opportunistic Candida spp. and Actinomyces infections. A total of seven surgical debridements were performed; fortunately, the patient survived. We discuss the presentation, diagnosis and management of this case including primary reconstruction of the soft tissue defects, and review the literature on necrotizing soft tissue infections as a clinical entity, incorporating clinical updates from the latest guidelines worldwide. Level of Evidence: Level V, therapeutic study.

Original languageEnglish
Pages (from-to)399-404
Number of pages6
JournalEuropean Journal of Plastic Surgery
Issue number4
Publication statusPublished - 1 Aug 2019


  • Debridement
  • Human
  • Septic shock
  • Soft tissue infections
  • Upper extremity

Cite this