A Case Report of a Fulminant Necrotizing Fasciitis of the Upper Extremity in an Immunocompromised Patient

Necrotizing fasciitis (NF) is a rare, extremely aggressive, and limb-and-life-threatening soft tissue infection requiring emergent surgical intervention. Diagnosis is often delayed by nonspecific early findings, and immunocompromised patients are at particular risk for fulminant, atypical presentations. We present a case of a 70-year-old male with a remote history of multiple myeloma treated with stem cell transplant who developed extensive NF of the right upper extremity within 24 hours of minor blunt trauma. Despite emergent surgical debridement, the patient progressed to septic shock and ultimately required above-elbow amputation. He was recovering well at the four-month follow-up visit. This case highlights the diagnostic challenge posed by NF following trivial trauma in patients with occult or remote immunosuppression and underscores the importance of a low threshold for surgical exploration when clinical suspicion is high despite an unimpressive mechanism of injury.