Case report: Necrotizing fasciitis involving the bilateral scrotum and right leg caused by Streptococcus pyogenes in a healthy male: a multidisciplinary diagnostic and therapeutic analysis

Abstract Introduction Necrotizing fasciitis (NF) following minor trauma in healthy individuals is rare and poses a considerable diagnostic challenge. Due to its nonspecific early presentation, NF is associated with high rates of misdiagnosis and mortality, underscoring the critical need for early recognition and intervention. Case presentation A previously healthy 37-year-old male developed rapidly progressive necrotizing fasciitis of the scrotum and right lower extremity following minor bicycle-related abrasions. Upon admission, the patient presented with a high-risk Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score of 8, and imaging studies demonstrated rapid spread of infection from the right inguinal region to the right lower extremity and perineum, with subsequent progression to septic shock and multiple organ dysfunction syndrome. Urgent multidisciplinary team (MDT) collaboration is critical. Through emergency fasciotomy and identification of Group A Streptococcus (GAS) infection, the diagnosis of NF was definitively established. Combined with high-dose penicillin G, and comprehensive supportive measures, he achieved complete recovery without sequelae at 6-month follow-up. Conclusions Type II NF related with GAS can even occurred in low-risk populations. Early diagnosis relies on LRINEC scoring combined with imaging. Time-critical MDT with immediate coordination for pathogen identificationis crucial for survival. Clinical trial number Not applicable.