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

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 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report 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Diagnostic and Therapeutic Analysis Xiaohua Li, Jianbo Xing, Wuyunbilige Bao, Yu Fu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6497643/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Feb, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted 13 You are reading this latest preprint version Abstract Introduction: Necrotizing fasciitis (NF) in healthy individuals following minor trauma is rare. This represents the first documented case of bilateral scrotal and right leg NF in an otherwise healthy male, triggered by bicycle-related abrasion. It high lights a unique synergistic infection pathway involving Streptococcus pyogenes . This case expands our understanding of NF triggers in low-risk populations and underscores the role of atypical trauma in fulminant infections. Case Presentation: A 37-year-old immunocompetent male developed progressive scrotal pain and swelling following minor trauma. Included: LRINEC_score: 8 (high-risk category); CT imaging: extensive subcutaneous edema; microbiological confirmation: Streptococcus pyogenes identified via MALDI-TOFMS; and Inflammatory markers: C-reactive protein (CRP) > 300 mg/L, pro-calcitonin (PCT) > 100 ng/mL. The patient was admitted to the intensive care unit (ICU), where he received targeted antimicrobial therapy, continuous veno-venous hemofiltration (CVVH), and high-dose immunoglobulin shock therapy. Within 72 hours, the surgical team performed fasciotomy and vacuum-assisted closure. Antibiotic therapy was adjusted to penicillin based on pathogen susceptibility results. The patient achieved full functional recovery at six-month follow-up. Conclusions This case underscores that NF can arise from seemingly trivial injuries, even in low-risk populations. Early diagnosis relies on LRINEC scoring combined with imaging. Time-critical multidisciplinary team (MDT) collaboration, with immediate coordination for pathogen identification within 24 hours and urgent surgical debridement within 72 hours, is crucial for survival. Standardized post-trauma infection screening and MDT protocols should be emphasized in primary care settings. Necrotizing Fasciitis Streptococcus pyogenes Multidisciplinary Communication Case Report Figures Figure 1 Figure 2 Figure 3 Introduction Necrotizing Fasciitis is a rapidly progressing soft tissue infection involving the superficial fascia and adjacent structures (skin, adipose tissue, fascia, and muscles), with a mortality rate exceeding 20% ( 1 ). When NF affects the perineal region, it is classified as Fournier’s gangrene ( 2 ). Here, we report a rare case of a previously healthy 37-year-old male who developed type II Fournier's gangrene secondary to Streptococcus pyogenes infection. The infection manifested as acute, severe pain with rapid bidirectional spread along the scrotal-inguinal axis, involving the lower abdominal wall and right lower limb. To our knowledge, this is the first reported case in China of such extensive NF triggered by minor trauma. Case Presentation We present a rare case of Streptococcus pyogenes induced NF in an immunocompetent individual, illustrating the clinical significance of this infection pathway. A 37-year-old male with no history of diabetes or immunosuppression presented with progressive bilateral scrotal pain and swelling. On March 19, 2022, he consumed alcohol and remained in a prolonged lateral recumbent position. The next day, he developed scrotal discomfort after cycling, which was initially misdiagnosed as testicular torsion via ultrasound at a local hospital. No intervention was performed. As his symptoms worsened, he was admitted to our hospital on the night of March 21. Clinical findings on admission included a body temperature of 36.3°C, a heart rate of 117 beats/min and a blood pressure of 110/82 mm Hg. Physical examination revealed bilateral scrotal erythema with purple discoloration, severe tenderness, and significant swelling with intense pain extending to the right medial thigh. Laboratory findings showed significant systemic inflammation(Table 1 ): leukocytosis (white blood cell count 12.43×10⁹/L, neutrophils 91.4%), elevated C-reactive protein (CRP 282.74 mg/L), and pro-calcitonin (PCT 59.32 ng/mL). Electrolyte and renal function abnormalities included hyponatremia (134.9 mmol/L) and acute kidney injury (serum creatinine 199 µmol/L). Based on these findings, the patient had an LRINEC_score of 8, placing him in the high-risk category for NF (Table 2 ). This classification was based on CRP ≥ 150 mg/L, serum sodium 141 µmol/L. Table 1 Admission laboratory findings Parameter Value Reference range White blood cell count (WBC) 12.43 ×10⁹/L 3.5–9.5 ×10⁹/L Neutrophils (%) 91.4% 50–70% C-reactive protein (CRP) 282.74 mg/L 0–6 mg/L Pro-calcitonin (PCT) 59.32 ng/mL 0–0.046 ng/mL Serum creatinine (Scr) 199 µmol/L 59–104 µmol/L Hemoglobin 169 g/L 130–175 g/L Serum sodium 134.9 mmol/L 137.0–147.0 mmol/L Random blood glucose* 7.98 mmol/L 4.11–5.89 mmol/L *Random blood glucose measurement and fasting and oral glucose tolerance test confirmed no diabetes. Table 2 LRINEC scoring criteria and case-specific evaluation (The LRINEC_score is a validated tool for distinguishing NF from non-necrotizing infections, based on six laboratory parameters: WBC, hemoglobin, sodium, glucose, creatinine and CRP ( 3 , 4 ). Parameter Value Score C-reactive protein (CRP) < 150 mg/L 0 ≥ 150 mg/L 4* White blood cell count (WBC) 25 × 10³/mm³ 2 Hemoglobin (Hb) > 135 g/L 0 110–135 g/L 1 < 110 g/L 2 Serum sodium (Na⁺) ≥ 135 mmol/L 0 141 µmol/L 2* Plasma glucose ≤ 10 mmol/L 0 > 10 mmol/L 1 Risk stratification Probability (%) Score Low risk 75 ≥ 8 Scoring was applied using symbols. Imaging findings: Ultrasound revealed soft tissue thickening in the right inguinal region with scrotal wall edema. Computed tomography (CT) demonstrated extensive subcutaneous soft tissue edema extending from the right hip to the pelvic floor and medial right thigh (Fig. 1 ). Therapeutic Intervention Night of March 21, 2022 (admission day) Initial misdiagnosis as "scrotal edema" led to empirical anti-inflammatory therapy with amikacin and fluid resuscitation, which failed to control disease progression. March 22 (within 24 hours): Dermatology consultation Misdiagnosed the condition as drug-induced dermatitis, prompting treatment with methylprednisolone (40 mg once daily) and topical Compound Huangbai Lotion. Department of Critical Care Medicine Initiatedempirical antimicrobial therapy with linezolid (0.6 g IV every 12 hours) in combination with meropenem (1.0 g IV every 8 hours), along with supportive care (fluid resuscitation, electrolyte correction, and scrotal decompression). Department of Laboratory Medicine Preliminary blood culture and wound smear results suggested Streptococcus pyogenes . Clinical deterioration Rapid infection spread triggered urgent multidisciplinary collaboration. March 24 (within 72 hours): Department of Laboratory Medicine MALDI-TOF MS confirmed Streptococcus pyogenes (99.9% confidence), demonstrating penicillin sensitivity (33 mm zone diameter) and clindamycin resistance (6 mm zone diameter). Department of Critical Care Medicine Adjusted the therapy to penicillin (4.8 million international units IV every 6 hours) + meropenem (1.0 g IV every 8 hours), supplemented with CVVH and high-dose intravenous immunoglobulin (IVIG, 20 g/day). Department of Burn and Plastic Surgery Performed an emergency decompressive fasciotomy from the right thigh to the right inguinal region to the suprapubic area, tissue and applying a vacuum-assisted closure (VAC) system. Intra operative findings included necrotic adipose tissue (grayish-white appearance), abundant interstitial exudate, and thrombosis in adipose layer vessels (Fig. 2 ). Postoperative Day 2 (Hospital Day 4) Dynamic monitoring of inflammatory markers showed a decline in CRP from a peak > 300 mg/L to 185.30 mg/L and PCT from > 100 ng/mL to 32.40 ng/mL(see serial trends in Fig. 3 ). Based on penicillin sensitivity, meropenem was discontinued and therapy was de-escalated to penicillin monotherapy following antibiotic stewardship protocols. Hospital Day 11 Secondary debridement of necrotic scrotal skin was performed at the Burns and Plastic Surgery. Hospital Day 14 (pre-transfer) Antimicrobial therapy was de-escalated with nutritional support. The Pharmacy Department discontinued meropenem based on antimicrobial susceptibility testing and switched to penicillin monotherapy. The Nutrition Department started intensive enteral nutrition (35 kcal/kg/day, protein 1.5 g/kg/day). Transfer to tertiary hospital (Hospital Day 17) The patient was transfer with a body temperature of 36.8°C, a blood pressure of 125/78 mm Hg, CRP of 15.3 mg/L, and PCT 0.32 ng/mL. Postoperative 6-month follow-up The wound healed favorably with no residual organ dysfunction (Fig. 2 b). No recurrence was reported by the patient up to manuscript submission. Discussion This case describes 37-year-old male who developed type II Fournier's gangrene (FG) secondary to Streptococcus pyogenes (GAS) infection. Diagnosis and radical debridement were completed within 72 hours of admission, highlighting the rapid progression and severity of GAS-induced NF. The infection spread aggressively with intense pain in the groin and lower abdomen, extending to the right leg, a pattern characteristic of GAS. In China, monomicrobial GAS-induced NF is rarely reported likely due to variations in hygiene and sanitation standards ( 5 , 6 ). In contrast, Western studies have shown that GAS accounts for 31%-66.6% of NF cases ( 7 – 11 ). This case demonstrates that NF can affect immunocompetent individuals following minor trauma. Although this is a single-center case report, it provides important clinical insights into the early recognition and management of GAS-related NF. Identifying and pinpointing the exact cause of necrotizing fasciitis (NF) early in its clinical management is crucial for improving clinical outcomes. Recent studies have reported that MCDA-LFB, a rapid detection method, can identify Streptococcus pyogenes within 46 minutes and facilitate timely targeted treatment ( 12 ). In China, GAS strains commonly exhibit high macrolide resistance, with clindamycin resistance rates reported at 88.9%-100%. Consequently, macrolide monotherapy is recommended forempirical treatment. Instead, clinician prioritize combinations such as penicillin with linezolid or vancomycin as first-line empirical therapies ( 13 – 16 ).These trends underscore the need for heightened vigilance regarding GAS virulence and its evolving resistance patterns. The non-specific early symptoms of NF, such as localized swelling or pain, often delay diagnosis. In this case, the patient’s primary complaint is a persistent, unrelenting pain unresponsive to oral analgesics, prompting hospital admission. A multidisciplinary team (MDT) approach, including real-time tele-consultation with a tertiary medical center, was crucial in guiding precision-based therapeutic strategies. The treatment strategy included stratified interventions such antimicrobial therapy and timely surgical debridement, which led to complete infection eradication while preserving the structural and functional integrity of affected tissues. Early surgical debridement (within 72 hours of admission), combined with dynamic monitoring of inflammatory biomarkers (CRP, PCT), approved to be a strong prognostic indicator. Antibiotic de-escalation from vancomycin to penicillin monotherapy, guided by susceptibility results, optimized antimicrobial precision and minimized unnecessary broad-spectrum antibiotic use. Adjunctive intravenous immunoglobulin (IVIG) therapy supported clinical stabilization by both neutralizing bacterial exotoxins and modulating dysregulated immune responses. The onset of infection was likely triggered by alcohol consumption. Several host and environmental factors contributed to infection development: The scrotal region’s anatomy, featuring loose and folded skin, elevated local temperature, and lipid- and protein-rich sweat secretions, created a microenvironment conducive to bacterial proliferation( 17 ). Alcohol intake compromised the skin’s epidermal lipid barrier ( 18 – 20 ), and when combined with cycling-induced epidermal microtrauma, enabled bacterial invasion. Prolonged lateral decubitus positioning post-alcohol consumption caused sustained local compression, leading to impaired microcirculatory perfusion and weakened innate immune defense. The pathogen's hypervirulent profile: including M protein-mediated immune evasion, hyaluronidase-driven fascial invasion, and exotoxin-induced microvascular thrombosis ( 6 , 21 ), further accelerated disease progression. Conclusion This case highlights several clinical and public health lessons: 1) Public health initiatives should emphasize personal hygiene education and prompt wound disinfection protocols management, especially for minor skin injuries;2) Diagnostic accuracy in suspected NF cases can be improved through early use of LRINEC scoring systems and rapid molecular diagnostics; 3)Standardized tele-consultation systems at primary care level can enhance early decision-making and coordination in complex infections; 4)Favorable NF outcomes rely on stratified therapeutic strategies supported by multidisciplinary team (MDT) collaboration; and 5)Future research should prioritize vaccine development targeting hyper-virulent Streptococcus pyogenes strains to reduce the global disease burden. Abbreviations NF: Necrotizing Fasciitis LRINEC: Laboratory Risk Indicator for Necrotizing Fasciitis CT: Computed Tomography CVVH: Continuous Veno-Venous Hemofiltration IVIG: Intravenous Immunoglobulin MDT: Multidisciplinary Team ESBL: Extended-Spectrum Beta-Lactamase MALDI-TOFMS: Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry VAC: Vacuum-Assisted Closure ICU: Intensive Care Unit GAS: Group A Streptococcus CRP: C-Reactive Protein PCT: Procalcitonin WBC: White Blood Cell count Scr: Serum Creatinine Na⁺: Serum Sodium Hb: Hemoglobin MCDA-LFB: Multiple Cross Displacement Amplification-Lateral Flow Biosensor ESBL: Extended-Spectrum β-Lactamase Declarations Acknowledgements We thank the patient and his family for their cooperation and consent to publish this case. Author Contributions Yu Fu: Study conceptualization and design Wuyunbilige Bao: interpretation and therapeutic decision-making processes. Jianbo Xing: interpretation and therapeutic decision-making processes. Xiaohua Li: case data acquisition, clinical documentation, and literature synthesisand critical revision of the manuscript. All authors participated in manuscript drafting, reviewed the final version, and approved its submission. Funding This study received no external funding. Clinical trial number Not applicable Data Availability The datasets and imaging materials supporting this case report are available from the corresponding author upon reasonable request. Ethics Approval and Consent to take part The Institutional Ethics Committee of [Central Hospital of Ordos City] (Approval No. 2025-331) approved this study. The patient provided written informed consent for participation and publication. Consent for Publication The patient provided written informed consent for the publication of clinical details, images, and laboratory data. All authors consent to the submission of this manuscript. Acknowledgements The authors would like to express their gratitude to EditSprings (https://www.editsprings.cn ) for the expert linguistic services provided. Competing Interests The authors declare no competing interests, financial or otherwise, related to this work. References Huang RS, Patil NS, Khan Y. Periorbital Necrotizing Fasciitis: Case Presentation. Interact J Med Res. 2023;12:e52507. Shaoban1 Z, LD, Shuntang2 L. Analysis of clinical characteristics and treatment of patients with perianal necrotizing fasciitis. Chin J Burns Wounds. 2024(10):955-62. Wu PH, Wu KH, Hsiao CT, Wu SR, Chang CP. Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections. World J Emerg Surg. 2021;16(1):26. Clinical Guidelines Committee CSBoCMDA. Chinese expert consensus on diagnosis and treatment of perianal necrotizing fasciitis (2019). Chin J Gastrointest Surg. 2019(07):689-93. Newberger R, Gupta V. Streptococcus Group A. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2024, StatPearls Publishing LLC.; 2024. Brouwer S, Rivera-Hernandez T, Curren BF, Harbison-Price N, De Oliveira DMP, Jespersen MG, et al. Pathogenesis, epidemiology and control of Group A Streptococcus infection. Nat Rev Microbiol. 2023;21(7):431-47. Wöhler A, Schwab R, Güsgen C, Schaaf S, Weitzel C, Jänig C, et al. [Diagnosis and Treatment of Severe Fournier's Gangrene: Introduction of a Surgical Approach, Evaluation of Risk Factors, Microbiological Characteristics and Review of the Literature]. Zentralbl Chir. 2022;147(5):480-91. Brébant V, Eschenbacher E, Hitzenbichler F, Pemmerl S, Prantl L, Pawlik M. Pathogens and their resistance behavior in necrotizing fasciitis. Clin Hemorheol Microcirc. 2024;86(1-2):169-81. Pérez-Sánchez I, Martínez-Gil L, Piqueras-Vidal PM, Pont-Gutiérez C, Cebrián-Gómez R, Montoza-Nuñez JM. [Translated article] Necrotising fasciitis: Management experience over the last two decades in our hospital. Rev Esp Cir Ortop Traumatol. 2022;66(6):T11-t9. Tam PCK, Kennedy B, Ashokan A. Necrotizing Soft Tissue Infections in South Australia: A 15-Year Review. Open Forum Infect Dis. 2023;10(4):ofad117. Zhang KF, Shi CX, Chen SY, Wei W. Progress in Multidisciplinary Treatment of Fournier's Gangrene. Infect Drug Resist. 2022;15:6869-80. Dou Z, Xie L, Gao M, Liu D. Development of a multiple cross displacement amplification combined with nanoparticles-based biosensor assay for rapid and sensitive detection of Streptococcus pyogenes. BMC Microbiol. 2024;24(1):51. Zhao Hailei ZX, Yang Bin, Shi Ming, Sun Zhigang. Comprehensive treatment of 25 cases of acute necrotizing fasciitis. Chin J Burns Wounds. 2021;37(04):382-5. Wang J, Ma C, Li M, Gao X, Wu H, Dong W, et al. Streptococcus pyogenes: Pathogenesis and the Current Status of Vaccines. Vaccines (Basel). 2023;11(9). Yinghua1 Z, YH, Wang Xiaoguang1 , He Yingying1 , Yan Hongjing1. Molecular epidemiological characteristics of Streptococcus pyogenes causing scarlet fever and angina in children. Chin J Microbiol Immunol. 2019(11):821-6. Li Xiao-Hua FY, Cao Xian, Zhang Yan-ling, Zhang Na. Distribution and Drug Resistance Analysis of Pathogenic Bacteria in Blood Stream Infection of Hospitalized Patients in a Hospital from 2017 to 2022. World Notes on Antibiotics. 2024;45(05):312-8. Powell LM, Choi SJ, Chipman CE, Grund ME, LaSala PR, Lukomski S. Emergence of Erythromycin-Resistant Invasive Group A Streptococcus, West Virginia, USA, 2020-2021. Emerg Infect Dis. 2023;29(5):898-908. Sperber GH. Clinically Oriented Anatomy. Journal of Anatomy. 2006;208(3):393. van der Heide FCT, Eussen S, Houben A, Henry RMA, Kroon AA, van der Kallen CJH, et al. Alcohol consumption and microvascular dysfunction: a J-shaped association: The Maastricht Study. Cardiovasc Diabetol. 2023;22(1):67. Liu L, Chen J. Advances in Relationship Between Alcohol Consumption and Skin Diseases. Clin Cosmet Investig Dermatol. 2023;16:3785-91. Jiao Q, Yue L, Zhi L, Qi Y, Yang J, Zhou C, et al. Studies on stratum corneum metabolism: function, molecular mechanism and influencing factors. J Cosmet Dermatol. 2022;21(8):3256-64. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Feb, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 06 Oct, 2025 Reviews received at journal 26 May, 2025 Reviewers agreed at journal 26 May, 2025 Reviews received at journal 23 May, 2025 Reviewers agreed at journal 23 May, 2025 Reviews received at journal 19 May, 2025 Reviewers agreed at journal 19 May, 2025 Reviewers agreed at journal 16 May, 2025 Reviewers invited by journal 15 May, 2025 Editor assigned by journal 13 May, 2025 Editor invited by journal 28 Apr, 2025 Submission checks completed at journal 28 Apr, 2025 First submitted to journal 28 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6497643","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":457490138,"identity":"71a409f1-b602-4931-baaf-7fa8423e8df8","order_by":0,"name":"Xiaohua Li","email":"","orcid":"","institution":"Ordos Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaohua","middleName":"","lastName":"Li","suffix":""},{"id":457490139,"identity":"7ac0f7e9-5192-4928-804f-c32eb45586b4","order_by":1,"name":"Jianbo Xing","email":"","orcid":"","institution":"Ordos Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jianbo","middleName":"","lastName":"Xing","suffix":""},{"id":457490140,"identity":"0347e49e-beee-47af-aaa4-ac453e49bc14","order_by":2,"name":"Wuyunbilige Bao","email":"","orcid":"","institution":"Ordos Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wuyunbilige","middleName":"","lastName":"Bao","suffix":""},{"id":457490141,"identity":"7e566f77-1529-4fdf-8285-72a8232965d1","order_by":3,"name":"Yu Fu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtklEQVRIiWNgGAWjYBAC9gYgwcPAIMfG3n6AOC08ByBajPl4ziSQpiVxnoSDAZFaJJKPfXhTUZfeJsGQwPCjYhsxWtKSZ845czi3TbrxAGPPmduEtdhL5Bgz87YdyG2TOZDAzNhGhBYeifzPQC116WwSCQbEaslhBmphTiBBC88zY0agXwzbgIF8kCi/8LAnP2YAhpi8fHv7wQc/KojQwiCQgGAfIEI9EPATqW4UjIJRMApGMAAAc5o32YPquxwAAAAASUVORK5CYII=","orcid":"","institution":"Ordos Central Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yu","middleName":"","lastName":"Fu","suffix":""}],"badges":[],"createdAt":"2025-04-21 16:23:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6497643/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6497643/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-026-12889-4","type":"published","date":"2026-02-17T15:58:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83150279,"identity":"2bb0674d-e9c7-408d-aa78-b91682114e1c","added_by":"auto","created_at":"2025-05-20 13:45:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1506852,"visible":true,"origin":"","legend":"\u003cp\u003eCT imaging showing subcutaneous soft tissue edema in the right hip, pelvic floor, and medialright thigh.\u003c/p\u003e\n\u003cp\u003eMicrobiological findings: Blood cultures identified \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e with susceptibility testing showing a penicillin inhibition zone diameter of 33 mm (sensitive) and an erythromycin inhibition zone diameter of 6 cm (resistant). Wound cultures identified \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e and \u003cem\u003eEscherichia coli\u003c/em\u003e (ESBL-), with potential contamination noted.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6497643/v1/3e256c20f3e83a51a57e1e4f.png"},{"id":83148879,"identity":"1cc94981-bc89-4682-aad6-d9204a660b62","added_by":"auto","created_at":"2025-05-20 13:29:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1227546,"visible":true,"origin":"","legend":"\u003cp\u003ea: Postoperative view after initial debridement.\u003c/p\u003e\n\u003cp\u003eb: Healing outcome following split-thickness skin grafting.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6497643/v1/7964a06478be9acb0c5b8b3c.png"},{"id":83148881,"identity":"1fdd7a6a-1700-4f5c-af5a-dbeb434fbf02","added_by":"auto","created_at":"2025-05-20 13:29:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":232085,"visible":true,"origin":"","legend":"\u003cp\u003eTrends of CRP and PCT levels over time.\u003c/p\u003e\n\u003cp\u003eSymbols:\u003cstrong\u003e●\u003c/strong\u003eEmpirical antibiotic phase; \u003cstrong\u003e◆\u003c/strong\u003eAntibiotic change with initial debridement; \u003cstrong\u003e※\u003c/strong\u003ePost-debridement phase.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6497643/v1/a6cd76cede4ab9011edd23dd.png"},{"id":103252363,"identity":"aaa7332d-10e4-42c7-a331-483420062399","added_by":"auto","created_at":"2026-02-23 16:14:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5604256,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6497643/v1/9c134342-ad13-419b-b50f-949461428c2d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eCase Report: Necrotizing Fasciitis Involving the Bilateral Scrotum and Right Leg Caused by \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e in a Healthy Male: A Multidisciplinary Diagnostic and Therapeutic Analysis\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNecrotizing Fasciitis is a rapidly progressing soft tissue infection involving the superficial fascia and adjacent structures (skin, adipose tissue, fascia, and muscles), with a mortality rate exceeding 20% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). When NF affects the perineal region, it is classified as Fournier\u0026rsquo;s gangrene (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Here, we report a rare case of a previously healthy 37-year-old male who developed type II Fournier's gangrene secondary to \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e infection. The infection manifested as acute, severe pain with rapid bidirectional spread along the scrotal-inguinal axis, involving the lower abdominal wall and right lower limb. To our knowledge, \u003cb\u003ethis is\u003c/b\u003e the first reported case in China of such extensive NF triggered by minor trauma.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eWe present a rare case of Streptococcus pyogenes induced NF in an immunocompetent individual, illustrating the clinical significance of this infection pathway. A 37-year-old male with no history of diabetes or immunosuppression presented with progressive bilateral scrotal pain and swelling. On March 19, 2022, he consumed alcohol and remained in a prolonged lateral recumbent position. The next day, he developed scrotal discomfort after cycling, which was initially misdiagnosed as testicular torsion via ultrasound at a local hospital. No intervention was performed. As his symptoms worsened, he was admitted to our hospital on the night of March 21.\u003c/p\u003e \u003cp\u003eClinical findings on admission included a body temperature of 36.3\u0026deg;C, a heart rate of 117 beats/min and a blood pressure of 110/82 mm Hg. Physical examination revealed bilateral scrotal erythema with purple discoloration, severe tenderness, and significant swelling with intense pain extending to the right medial thigh.\u003c/p\u003e \u003cp\u003eLaboratory findings showed significant systemic inflammation(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e): leukocytosis (white blood cell count 12.43\u0026times;10⁹/L, neutrophils 91.4%), elevated C-reactive protein (CRP 282.74 mg/L), and pro-calcitonin (PCT 59.32 ng/mL). Electrolyte and renal function abnormalities included hyponatremia (134.9 mmol/L) and acute kidney injury (serum creatinine 199 \u0026micro;mol/L). Based on these findings, the patient had an LRINEC_score of 8, placing him in the high-risk category for NF (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This classification was based on CRP\u0026thinsp;\u0026ge;\u0026thinsp;150 mg/L, serum sodium\u0026thinsp;\u0026lt;\u0026thinsp;135 mmol/L and creatinine\u0026thinsp;\u0026gt;\u0026thinsp;141 \u0026micro;mol/L.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAdmission laboratory findings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference range\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cell count (WBC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.43 \u0026times;10⁹/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5\u0026ndash;9.5 \u0026times;10⁹/L\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophils (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u0026ndash;70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-reactive protein (CRP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e282.74 mg/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;6 mg/L\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePro-calcitonin (PCT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.32 ng/mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;0.046 ng/mL\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum creatinine (Scr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e199 \u0026micro;mol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u0026ndash;104 \u0026micro;mol/L\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e169 g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130\u0026ndash;175 g/L\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum sodium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134.9 mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137.0\u0026ndash;147.0 mmol/L\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRandom blood glucose*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.98 mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.11\u0026ndash;5.89 mmol/L\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Random blood glucose measurement and fasting and oral glucose tolerance test confirmed no diabetes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLRINEC scoring criteria and case-specific evaluation (The LRINEC_score is a validated tool for distinguishing NF from non-necrotizing infections, based on six laboratory parameters: WBC, hemoglobin, sodium, glucose, creatinine and CRP (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-reactive protein (CRP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;150 mg/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;150 mg/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cell count (WBC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;15 \u0026times; 10\u0026sup3;/mm\u0026sup3;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;25 \u0026times; 10\u0026sup3;/mm\u0026sup3;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;25 \u0026times; 10\u0026sup3;/mm\u0026sup3;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (Hb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;135 g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110\u0026ndash;135 g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;110 g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum sodium (Na⁺)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;135 mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;135 mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum creatinine (Scr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;141 \u0026micro;mol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;141 \u0026micro;mol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlasma glucose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;10 mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk stratification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProbability (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntermediate risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eScoring was applied using symbols.\u003c/p\u003e \u003cp\u003eImaging findings: Ultrasound revealed soft tissue thickening in the right inguinal region with scrotal wall edema. Computed tomography (CT) demonstrated extensive subcutaneous soft tissue edema extending from the right hip to the pelvic floor and medial right thigh (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003ch2\u003eTherapeutic Intervention\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eNight of March 21, 2022 (admission day)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInitial misdiagnosis as \u0026quot;scrotal edema\u0026quot; led to empirical anti-inflammatory therapy with amikacin and fluid resuscitation, which failed to control disease progression.\u003c/p\u003e\n\u003ch3\u003eMarch 22 (within 24 hours):\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eDermatology consultation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMisdiagnosed the condition as drug-induced dermatitis, prompting treatment with methylprednisolone (40 mg once daily) and topical Compound Huangbai Lotion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepartment of Critical Care Medicine\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInitiatedempirical antimicrobial therapy with linezolid (0.6 g IV every 12 hours) in combination with meropenem (1.0 g IV every 8 hours), along with supportive care (fluid resuscitation, electrolyte correction, and scrotal decompression).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepartment of Laboratory Medicine\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePreliminary blood culture and wound smear results suggested \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical deterioration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRapid infection spread triggered urgent multidisciplinary collaboration.\u003c/p\u003e\n\u003ch3\u003eMarch 24 (within 72 hours):\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eDepartment of Laboratory Medicine\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMALDI-TOF MS confirmed \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e (99.9% confidence), demonstrating penicillin sensitivity (33 mm zone diameter) and clindamycin resistance (6 mm zone diameter).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepartment of Critical Care Medicine\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdjusted the therapy to penicillin (4.8\u0026nbsp;million international units IV every 6 hours)\u0026thinsp;+\u0026thinsp;meropenem (1.0 g IV every 8 hours), supplemented with CVVH and high-dose intravenous immunoglobulin (IVIG, 20 g/day).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepartment of Burn and Plastic Surgery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePerformed an emergency decompressive fasciotomy from the right thigh to the right inguinal region to the suprapubic area, tissue and applying a vacuum-assisted closure (VAC) system. Intra operative findings included necrotic adipose tissue (grayish-white appearance), abundant interstitial exudate, and thrombosis in adipose layer vessels (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative Day 2 (Hospital Day 4)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDynamic monitoring of inflammatory markers showed a decline in CRP from a peak\u0026thinsp;\u0026gt;\u0026thinsp;300 mg/L to 185.30 mg/L and PCT from \u0026gt;\u0026thinsp;100 ng/mL to 32.40 ng/mL(see serial trends in Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eBased on penicillin sensitivity, meropenem was discontinued and therapy was de-escalated to penicillin monotherapy following antibiotic stewardship protocols.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHospital Day 11\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSecondary debridement of necrotic scrotal skin was performed at the Burns and Plastic Surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHospital Day 14 (pre-transfer)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAntimicrobial therapy was de-escalated with nutritional support. The Pharmacy Department discontinued meropenem based on antimicrobial susceptibility testing and switched to penicillin monotherapy. The Nutrition Department started intensive enteral nutrition (35 kcal/kg/day, protein 1.5 g/kg/day).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTransfer to tertiary hospital (Hospital Day 17)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient was transfer with a body temperature of 36.8\u0026deg;C, a blood pressure of 125/78 mm Hg, CRP of 15.3 mg/L, and PCT 0.32 ng/mL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative 6-month follow-up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe wound healed favorably with no residual organ dysfunction (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eb). No recurrence was reported by the patient up to manuscript submission.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis case describes 37-year-old male who developed type II Fournier's gangrene (FG) secondary to \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e (GAS) infection. Diagnosis and radical debridement were completed within 72 hours of admission, highlighting the rapid progression and severity of GAS-induced NF. The infection spread aggressively with intense pain in the groin and lower abdomen, extending to the right leg, a pattern characteristic of GAS. In China, monomicrobial GAS-induced NF is rarely reported likely due to variations in hygiene and sanitation standards (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In contrast, Western studies have shown that GAS accounts for 31%-66.6% of NF cases (\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). This case demonstrates that NF can affect immunocompetent individuals following minor trauma. Although this is a single-center case report, it provides important clinical insights into the early recognition and management of GAS-related NF.\u003c/p\u003e \u003cp\u003eIdentifying and pinpointing the exact cause of necrotizing fasciitis (NF) early in its clinical management is crucial for improving clinical outcomes. Recent studies have reported that MCDA-LFB, a rapid detection method, can identify \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e within 46 minutes and facilitate timely targeted treatment (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In China, GAS strains commonly exhibit high macrolide resistance, with clindamycin resistance rates reported at 88.9%-100%. Consequently, macrolide monotherapy is recommended forempirical treatment. Instead, clinician prioritize combinations such as penicillin with linezolid or vancomycin as first-line empirical therapies (\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).These trends underscore the need for heightened vigilance regarding GAS virulence and its evolving resistance patterns.\u003c/p\u003e \u003cp\u003eThe non-specific early symptoms of NF, such as localized swelling or pain, often delay diagnosis. In this case, the patient\u0026rsquo;s primary complaint is a persistent, unrelenting pain unresponsive to oral analgesics, prompting hospital admission. A multidisciplinary team (MDT) approach, including real-time tele-consultation with a tertiary medical center, was crucial in guiding precision-based therapeutic strategies. The treatment strategy included stratified interventions such antimicrobial therapy and timely surgical debridement, which led to complete infection eradication while preserving the structural and functional integrity of affected tissues. Early surgical debridement (within 72 hours of admission), combined with dynamic monitoring of inflammatory biomarkers (CRP, PCT), approved to be a strong prognostic indicator. Antibiotic de-escalation from vancomycin to penicillin monotherapy, guided by susceptibility results, optimized antimicrobial precision and minimized unnecessary broad-spectrum antibiotic use. Adjunctive intravenous immunoglobulin (IVIG) therapy supported clinical stabilization by both neutralizing bacterial exotoxins and modulating dysregulated immune responses.\u003c/p\u003e \u003cp\u003eThe onset of infection was likely triggered by alcohol consumption. Several host and environmental factors contributed to infection development: The scrotal region\u0026rsquo;s anatomy, featuring loose and folded skin, elevated local temperature, and lipid- and protein-rich sweat secretions, created a microenvironment conducive to bacterial proliferation(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Alcohol intake compromised the skin\u0026rsquo;s epidermal lipid barrier (\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), and when combined with cycling-induced epidermal microtrauma, enabled bacterial invasion. Prolonged lateral decubitus positioning post-alcohol consumption caused sustained local compression, leading to impaired microcirculatory perfusion and weakened innate immune defense. The pathogen's hypervirulent profile: including M protein-mediated immune evasion, hyaluronidase-driven fascial invasion, and exotoxin-induced microvascular thrombosis (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), further accelerated disease progression.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case highlights several clinical and public health lessons: 1) Public health initiatives should emphasize personal hygiene education and prompt wound disinfection protocols management, especially for minor skin injuries;2) Diagnostic accuracy in suspected NF cases can be improved through early use of LRINEC scoring systems and rapid molecular diagnostics; 3)Standardized tele-consultation systems at primary care level can enhance early decision-making and coordination in complex infections; 4)Favorable NF outcomes rely on stratified therapeutic strategies supported by multidisciplinary team (MDT) collaboration; and 5)Future research should prioritize vaccine development targeting hyper-virulent \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e strains to reduce the global disease burden.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eNF: Necrotizing Fasciitis\u003c/p\u003e\n\u003cp\u003eLRINEC: Laboratory Risk Indicator for Necrotizing Fasciitis\u003c/p\u003e\n\u003cp\u003eCT: Computed Tomography\u003c/p\u003e\n\u003cp\u003eCVVH: Continuous Veno-Venous Hemofiltration\u003c/p\u003e\n\u003cp\u003eIVIG: Intravenous Immunoglobulin\u003c/p\u003e\n\u003cp\u003eMDT: Multidisciplinary Team\u003c/p\u003e\n\u003cp\u003eESBL: Extended-Spectrum Beta-Lactamase\u003c/p\u003e\n\u003cp\u003eMALDI-TOFMS: Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry\u003c/p\u003e\n\u003cp\u003eVAC: Vacuum-Assisted Closure\u003c/p\u003e\n\u003cp\u003eICU: Intensive Care Unit\u003c/p\u003e\n\u003cp\u003eGAS: Group A Streptococcus\u003c/p\u003e\n\u003cp\u003eCRP: C-Reactive Protein\u003c/p\u003e\n\u003cp\u003ePCT: Procalcitonin\u003c/p\u003e\n\u003cp\u003eWBC: White Blood Cell count\u003c/p\u003e\n\u003cp\u003eScr: Serum Creatinine\u003c/p\u003e\n\u003cp\u003eNa⁺: Serum Sodium\u003c/p\u003e\n\u003cp\u003eHb: Hemoglobin\u003c/p\u003e\n\u003cp\u003eMCDA-LFB: Multiple Cross Displacement Amplification-Lateral Flow Biosensor\u003c/p\u003e\n\u003cp\u003eESBL: Extended-Spectrum \u0026beta;-Lactamase\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the patient and his family for their cooperation and consent to publish this case.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYu Fu: Study conceptualization and design\u003c/p\u003e\n\u003cp\u003eWuyunbilige Bao: interpretation and therapeutic decision-making processes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJianbo Xing: interpretation and therapeutic decision-making processes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eXiaohua Li: case data acquisition, clinical documentation, and literature synthesisand critical revision of the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors participated in manuscript drafting, reviewed the final version, and approved its submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets and imaging materials supporting this case report are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to take part\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Institutional Ethics Committee of [Central Hospital of Ordos City] (Approval No. 2025-331) approved this study. The patient provided written informed consent for participation and publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient provided written informed consent for the publication of clinical details, images, and laboratory data. All authors consent to the submission of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude to EditSprings (https://www.editsprings.cn ) for the expert linguistic services provided.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests, financial or otherwise, related to this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHuang RS, Patil NS, Khan Y. Periorbital Necrotizing Fasciitis: Case Presentation. Interact J Med Res. 2023;12:e52507.\u003c/li\u003e\n\u003cli\u003eShaoban1 Z, LD, Shuntang2 L. Analysis of clinical characteristics and treatment of patients with perianal necrotizing fasciitis. Chin J Burns Wounds. 2024(10):955-62.\u003c/li\u003e\n\u003cli\u003eWu PH, Wu KH, Hsiao CT, Wu SR, Chang CP. Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections. World J Emerg Surg. 2021;16(1):26.\u003c/li\u003e\n\u003cli\u003eClinical Guidelines Committee CSBoCMDA. Chinese expert consensus on diagnosis and treatment of perianal necrotizing fasciitis (2019). Chin J Gastrointest Surg. 2019(07):689-93.\u003c/li\u003e\n\u003cli\u003eNewberger R, Gupta V. Streptococcus Group A. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright \u0026copy; 2024, StatPearls Publishing LLC.; 2024.\u003c/li\u003e\n\u003cli\u003eBrouwer S, Rivera-Hernandez T, Curren BF, Harbison-Price N, De Oliveira DMP, Jespersen MG, et al. Pathogenesis, epidemiology and control of Group A Streptococcus infection. Nat Rev Microbiol. 2023;21(7):431-47.\u003c/li\u003e\n\u003cli\u003eW\u0026ouml;hler A, Schwab R, G\u0026uuml;sgen C, Schaaf S, Weitzel C, J\u0026auml;nig C, et al. [Diagnosis and Treatment of Severe Fournier\u0026apos;s Gangrene: Introduction of a Surgical Approach, Evaluation of Risk Factors, Microbiological Characteristics and Review of the Literature]. Zentralbl Chir. 2022;147(5):480-91.\u003c/li\u003e\n\u003cli\u003eBr\u0026eacute;bant V, Eschenbacher E, Hitzenbichler F, Pemmerl S, Prantl L, Pawlik M. Pathogens and their resistance behavior in necrotizing fasciitis. Clin Hemorheol Microcirc. 2024;86(1-2):169-81.\u003c/li\u003e\n\u003cli\u003eP\u0026eacute;rez-S\u0026aacute;nchez I, Mart\u0026iacute;nez-Gil L, Piqueras-Vidal PM, Pont-Guti\u0026eacute;rez C, Cebri\u0026aacute;n-G\u0026oacute;mez R, Montoza-Nu\u0026ntilde;ez JM. [Translated article] Necrotising fasciitis: Management experience over the last two decades in our hospital. Rev Esp Cir Ortop Traumatol. 2022;66(6):T11-t9.\u003c/li\u003e\n\u003cli\u003eTam PCK, Kennedy B, Ashokan A. Necrotizing Soft Tissue Infections in South Australia: A 15-Year Review. Open Forum Infect Dis. 2023;10(4):ofad117.\u003c/li\u003e\n\u003cli\u003eZhang KF, Shi CX, Chen SY, Wei W. Progress in Multidisciplinary Treatment of Fournier\u0026apos;s Gangrene. Infect Drug Resist. 2022;15:6869-80.\u003c/li\u003e\n\u003cli\u003eDou Z, Xie L, Gao M, Liu D. Development of a multiple cross displacement amplification combined with nanoparticles-based biosensor assay for rapid and sensitive detection of Streptococcus pyogenes. BMC Microbiol. 2024;24(1):51.\u003c/li\u003e\n\u003cli\u003eZhao Hailei ZX, Yang Bin, Shi Ming, Sun Zhigang. Comprehensive treatment of 25 cases of acute necrotizing fasciitis. Chin J Burns Wounds. 2021;37(04):382-5.\u003c/li\u003e\n\u003cli\u003eWang J, Ma C, Li M, Gao X, Wu H, Dong W, et al. Streptococcus pyogenes: Pathogenesis and the Current Status of Vaccines. Vaccines (Basel). 2023;11(9).\u003c/li\u003e\n\u003cli\u003eYinghua1 Z, YH, Wang Xiaoguang1 , He Yingying1 , Yan Hongjing1. Molecular epidemiological characteristics of Streptococcus pyogenes causing scarlet fever and angina in children. Chin J Microbiol Immunol. 2019(11):821-6.\u003c/li\u003e\n\u003cli\u003eLi Xiao-Hua FY, Cao Xian, Zhang Yan-ling, Zhang Na. Distribution and Drug Resistance Analysis of Pathogenic Bacteria in Blood Stream Infection of Hospitalized Patients in a Hospital from 2017 to 2022. World Notes on Antibiotics. 2024;45(05):312-8.\u003c/li\u003e\n\u003cli\u003ePowell LM, Choi SJ, Chipman CE, Grund ME, LaSala PR, Lukomski S. Emergence of Erythromycin-Resistant Invasive Group A Streptococcus, West Virginia, USA, 2020-2021. Emerg Infect Dis. 2023;29(5):898-908.\u003c/li\u003e\n\u003cli\u003eSperber GH. Clinically Oriented Anatomy. Journal of Anatomy. 2006;208(3):393.\u003c/li\u003e\n\u003cli\u003evan der Heide FCT, Eussen S, Houben A, Henry RMA, Kroon AA, van der Kallen CJH, et al. Alcohol consumption and microvascular dysfunction: a J-shaped association: The Maastricht Study. Cardiovasc Diabetol. 2023;22(1):67.\u003c/li\u003e\n\u003cli\u003eLiu L, Chen J. Advances in Relationship Between Alcohol Consumption and Skin Diseases. Clin Cosmet Investig Dermatol. 2023;16:3785-91.\u003c/li\u003e\n\u003cli\u003eJiao Q, Yue L, Zhi L, Qi Y, Yang J, Zhou C, et al. Studies on stratum corneum metabolism: function, molecular mechanism and influencing factors. J Cosmet Dermatol. 2022;21(8):3256-64.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Necrotizing Fasciitis, Streptococcus pyogenes, Multidisciplinary Communication, Case Report","lastPublishedDoi":"10.21203/rs.3.rs-6497643/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6497643/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eNecrotizing fasciitis (NF) in healthy individuals following minor trauma is rare. This represents the first documented case of bilateral scrotal and right leg NF in an otherwise healthy male, triggered by bicycle-related abrasion. It high lights a unique synergistic infection pathway involving \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e. This case expands our understanding of NF triggers in low-risk populations and underscores the role of atypical trauma in fulminant infections.\u003c/p\u003e\u003ch2\u003eCase Presentation:\u003c/h2\u003e \u003cp\u003eA 37-year-old immunocompetent male developed progressive scrotal pain and swelling following minor trauma. Included: LRINEC_score: 8 (high-risk category); CT imaging: extensive subcutaneous edema; microbiological confirmation: \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e identified via MALDI-TOFMS; and Inflammatory markers: C-reactive protein (CRP)\u0026thinsp;\u0026gt;\u0026thinsp;300 mg/L, pro-calcitonin (PCT)\u0026thinsp;\u0026gt;\u0026thinsp;100 ng/mL. The patient was admitted to the intensive care unit (ICU), where he received targeted antimicrobial therapy, continuous veno-venous hemofiltration (CVVH), and high-dose immunoglobulin shock therapy. Within 72 hours, the surgical team performed fasciotomy and vacuum-assisted closure. Antibiotic therapy was adjusted to penicillin based on pathogen susceptibility results. The patient achieved full functional recovery at six-month follow-up.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis case underscores that NF can arise from seemingly trivial injuries, even in low-risk populations. Early diagnosis relies on LRINEC scoring combined with imaging. Time-critical multidisciplinary team (MDT) collaboration, with immediate coordination for pathogen identification within 24 hours and urgent surgical debridement within 72 hours, is crucial for survival. Standardized post-trauma infection screening and MDT protocols should be emphasized in primary care settings.\u003c/p\u003e","manuscriptTitle":"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","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-20 13:29:08","doi":"10.21203/rs.3.rs-6497643/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-06T09:58:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-26T06:42:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106991468819269154722146628425163664030","date":"2025-05-26T06:30:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-23T08:33:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"289297690761647441900019422220826307921","date":"2025-05-23T08:19:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-19T17:36:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"175868183626459675134665365324663901057","date":"2025-05-19T16:51:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51328329828982999221770357416323639491","date":"2025-05-16T08:09:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-15T18:18:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-13T08:21:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-29T03:13:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-28T09:22:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-04-28T09:21:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eb7da850-b15f-4a34-b9c5-ebd6d68d44ee","owner":[],"postedDate":"May 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:12:02+00:00","versionOfRecord":{"articleIdentity":"rs-6497643","link":"https://doi.org/10.1186/s12879-026-12889-4","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2026-02-17 15:58:23","publishedOnDateReadable":"February 17th, 2026"},"versionCreatedAt":"2025-05-20 13:29:08","video":"","vorDoi":"10.1186/s12879-026-12889-4","vorDoiUrl":"https://doi.org/10.1186/s12879-026-12889-4","workflowStages":[]},"version":"v1","identity":"rs-6497643","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6497643","identity":"rs-6497643","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}