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While more men are affected than women at a 3-to-1 ratio, overall NF mortality ranges from 8.7% to 73%. Abnormal vital signs may include fever, hypotension, tachycardia, and tachypnea. In NF’s most severe form, patients present with pain out of proportion to the examination, subcutaneous emphysema, erythema, and necrosis at the site of the cutaneous infection. To provide the greatest possibility for survival, it is vital to expeditiously identify the presence of NF. NF rapidly expands along fascial planes and can further expand into the thighs, buttocks, and anterior abdominal wall. The presence of cellulitis occurs over infected subcutaneous tissue and fascia and eventually may lead to necrosis of the skin and muscles. Necrotizing fasciitis (NF) of the perineum, groin, and genitalia (historically referred to as Fournier’s Gangrene (FG) ) is a devastating, soft tissue disease causing fulminant clinical deterioration in any patient regardless of the patient’s immune status. While retroperitoneal NF is consistent with uniformly poor outcomes, patients are best treated in an American Burn Association-verified burn center. The best chance for survival occurs with emergent surgical debridement and appropriate intravenous antibiotics. NF is a sinister and fulminant disease requiring prompt diagnosis and surgical intervention. After colostomy placement, antibiotic administration, and wound care, he was closed using split-thickness skin grafting. Multiple surgical debridements to his perineum, deep pelvic structures, and retroperitoneum were completed. A computerized tomographic scan revealed air and fluid in the perineum and pelvis, ascending into the retroperitoneum. He was diagnosed with the human immunodeficiency virus upon presentation. A 55-year-old male presented with hypotension requiring a large intravenous fluid resuscitation and vasopressors. Various clinical risk factors may render a weakness in the patient’s immune status including diabetes mellitus, chronic renal failure, obesity, and autoimmune disorders, such as a human immunodeficiency virus (HIV) infection. This disease process demands a strong clinical suspicion for early identification which must be coupled with frequent wide surgical debridements and intravenous antibiotics for improved outcomes.

Necrotizing fasciitis (NF) is a devastating soft tissue disease causing fulminant clinical deterioration, and extension into the retroperitoneum has a high mortality rate.

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