Necrotizing fasciitis appearing with petechiae as the first clinical sign

A 64-year-old Japanese man with necrotizing fasciitis is reported. He developed an Enterobacter agglomerans infection in his left leg without any known causative surgery or trauma, although he had acute myelocytic leukemia as a predisposing condition. Uncommonly, the first clinical sign was petechiae. Surgical debridement could not be performed because of pancytopenia due to his original disease and chemotherapy. The patient died, and an autopsy was performed. Severe intravascular coagulation was observed in the cutaneous infected tissues, while little or no disseminated intravascular coagulation was observed in the major internal organs. The local microorganism factors such as necrotoxins were suspected to cause the intravascular coagulation in the infected tissues.