Necrotizing fasciitis: clinical approach and diagnosis in DEA

We describe a case of a 85 years old man, presenting to our Emergency Department because of fever of recent onset, joint pain and erythema involving his left leg. Although the first clinical appearance looks like a benign-low grade cellulitis, it will rapidly progress in a necrotizing fasciitis, with systemic toxicity and septic shock. Necrotizing fasciitis is an uncommon but potentially fatal disease; Its aetiology is multifactorial. High clinical suspicious is essential for the Emergency Physician to make the diagnosis of necrotizing fasciitis, in particular way when a patient with predisposing factor come to his attention presenting a soft tissue infection with signs of Systemic Inflammatory Response Syndrome (SIRS). Early diagnosis, aggressive surgical and antibiotic treatments are essential for a favourable outcome.