Type 2 Necrotizing Soft Tissue Infection: A Disastrous Diagnosis Not To Be Missed

Necrotizing soft tissue infections (NSTIs) are severe, life-threatening forms of infection. Tissues from the epidermis to the deep musculature may be affected. This includes necrotizing forms of cellulitis, myositis, and fasciitis. Delayed diagnosis can lead to widespread tissue loss, limb loss, and mortality, representing a group of infectious surgical emergencies requiring time-sensitive aggressive debridement. This article presents a unique case with a particularly ambiguous and vague presentation of type 2, group A streptococcal NSTI in an intravenous drug abuser. This rapidly spreading infection subjected her to profound morbidity, with loss of all four extremities. Type 2 NSTIs are particularly challenging to diagnose as they often present without classic signs of skin changes, subcutaneous air, and crepitus. They also spread more rapidly and, as such, have a higher morbidity and mortality rate than type 1 NSTIs. We are striving to increase physician awareness of such cases, with the aim of earlier recognition and earlier limb and life-saving interventions.