Necrotizing Fasciitis Camouflaging As Cellulitis: A Case Report Highlighting Diagnostic Pitfalls

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection that is often misdiagnosed in its early stages due to clinical similarities with cellulitis. Early recognition and prompt surgical intervention are essential to reducing morbidity and mortality. This report presents one case of NF initially manifesting as cellulitis in a patient with multiple risk factors, including intravenous drug use and recent incarceration. Despite initial antibiotic therapy and transient clinical improvement, the patient experienced worsening pain and systemic symptoms. Imaging identified subcutaneous emphysema, leading to urgent surgical exploration that confirmed NF. This case highlights the importance of recognizing disproportionate pain, maintaining a high index of suspicion, and seeking early surgical consultation when NF is considered. The case was managed by family medicine residents and is presented to aid clinicians in recognizing and diagnosing NF among other potential conditions.