Background: Necrotizing soft tissue infection (NSTI) is an uncommon but devastating disease process. Multifocal NSTI is even more rare. Atypical presentations of NSTI delay definitive treatment with aggressive surgical debridement. Case Presentation: A 26-year-old Asian female who had undergone recent chemotherapy presented to the emergency department with vaginal bleeding. She was admitted for observation and developed rapidly progressive bilateral leg pain and ecchymosis. After the development of crepitus, the surgery team was consulted. Because of high suspicion for NSTI, she was taken to the operating room for surgical debridement. She was found to have extensive myonecrosis in her bilateral lower extremities necessitating amputations of both legs. Her left forearm was also explored, with all three extremities found to harbor gram-positive bacilli. Despite aggressive debridement and maximal intensive cares, the patient died on her first post-operative day because of Clostridium perfringens sepsis. Conclusion: Providers who care for immunocompromised patients must have a lower threshold to consider NSTI in their differential diagnosis. Immunocompromised patients may present in an atypical fashion, which delays diagnosis and treatment.
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