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 RozenEmail author
Case Report


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.


Human Soft tissue infections Upper extremity Septic shock Debridement 


Compliance with ethical standards

Conflict of interest

KS Tong, DC Williams, MA Seifman, DJ Hunter-Smith and WM Rozen declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Furness General HospitalCumbriaUK
  2. 2.Peninsula Clinical SchoolCentral Clinical School at Monash UniversityMelbourneAustralia
  3. 3.Department of Plastic and Reconstructive Surgery, Peninsula HealthFrankston HospitalFrankstonAustralia

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