Abstract

This case report presents a 49-year-old female with chronic wounds, methamphetamine use, and a history of recurrent cellulitis who developed severe bilateral lower extremity necrotizing fasciitis caused by methicillin-resistant Staphylococcus aureus (MRSA). The patient exhibited signs of rapidly progressing infection, systemic toxicity, and multiorgan dysfunction, including acute kidney injury and metabolic acidosis. However, her LRINEC score was low. The diagnosis was suspected based on clinical findings. Treatment involved immediate broad-spectrum antibiotics, aggressive surgical intervention, and hemodynamic support. She required extensive wound care during hospitalization. This case underscores the critical need for early diagnosis, surgical intervention, and multidisciplinary management in necrotizing fasciitis to improve patient outcomes. Clinicians should maintain a high suspicion of necrotizing fasciitis despite a low LRINEC score or negative imaging findings. Clinical findings and prompt surgical consultation are essential to evaluating necrotizing fasciitis. Although the LRINEC score is a helpful diagnostic tool, it cannot be solely relied upon due to its sensitivity ranging from 36-77% and specificity ranging from 72-93%. Prompt recognition and intervention remain paramount, as delays in diagnosis and treatment can lead to devastating outcomes.