Monomicrobial Gram-Negative Necrotizing Fasciitis of the Lower Extremity

Unlike other skin and soft tissue infections, necrotizing fasciitis (NF) is a rare and potentially life-threatening condition. It is usually caused by polymicrobial infections or monomicrobial gram-positive organisms, mainly Staphylococcus and Streptococcus. Monomicrobial gram-negative Escherichia coli (E. coli) NF is a rare form of NF, primarily reported in patients with underlying comorbidities or immunocompromised states. Here, we present a novel case of monomicrobial gram-negative NF caused by E. coli in an otherwise healthy patient. This case highlights that E. coli NF cannot be solely attributed to comorbidities, and physicians should be aware that NF can occur from E. coli infection in the absence of underlying health conditions.