Fatal Escherichia coli Necrotizing Fasciitis in a Patient With End-Stage Renal Disease and Type 2 Diabetes Mellitus

Necrotizing fasciitis (NF) is a rare but life-threatening soft tissue infection characterized by rapid necrosis of fascia and surrounding tissues. While NF is most commonly associated with group A Streptococcus or polymicrobial etiologies, monomicrobial cases due to Escherichia (E.) coli are uncommon. When they do occur, these infections are often highly virulent and frequently fatal, especially in immunocompromised patients. This report describes a fatal case of monomicrobial E. coli NF in a 64-year-old woman with end-stage renal disease (ESRD) on hemodialysis and type 2 diabetes mellitus. The infection originated from a urinary tract infection and vulvar abscess, culminating in septic shock and multiorgan failure. Blood and wound cultures grew E. coli. Despite aggressive resuscitation, broad-spectrum antibiotics, and emergent surgical debridement, the patient deteriorated rapidly and died within three days of admission. This case highlights the aggressive nature of gram-negative monomicrobial NF in immunocompromised patients and underscores the importance of early recognition, prompt surgical intervention, and multidisciplinary critical care management.