60-year-old female presents to the emergency department with fevers, chills, and decreased appetite. Patient also complaining of L leg pain that she noted 1-day prior. Patient with history of diabetes, breast cancer- currently getting chemotherapy, and hypertension. Vitals as follows: T: 100.3 (O), HR: 123, RR: 18, SpO2: 98% on RA. On physical exam, you notice a scab on the dorsum of the foot with surrounding erythema with bullae at the edge of the wound that patient did not have prior to coming to the hospital. What is the most likely problem?

A. Cellulitis

B. Necrotizing Fascitis 

C. Pemphigus Vulgaris

D. Stevens Johnson Syndrome

B. Necrotizing Fascitis. Patient is immunocompromised and a diabetic which puts her at an increased risk for necrotizing fasciitis. Pemphigus Vulgaris usually begins with blisters in the mouth and then skin or genital mucous membranes. Steven Johnson syndrome usually follows a reaction to a medication or an infection resulting in a painful red or purplish rash that spreads and blisters. Cellulitis is less likely but should be considered however patient’s rash is progressing rapidly.

Stevens, D, et al. "Necrotizing Soft-Tissue Infections." N Engl J Med 2017; 377:2253-2265. <https://www.nejm.org/doi/full/10.1056/NEJMra1600673>. 3/31/20

Berger, B. "Necrotizing Fascitis and the Spectrum of Soft Tissue Infections." Sept 2018. <http://www.tamingthesru.com/blog/2018/9/3/necrotizing-fasciitis-and-the-.... 3/31/20

Stevens, D, et al. "Necrotizing Soft-Tissue Infections." N Engl J Med 2017; 377:2253-2265. <https://www.nejm.org/doi/full/10.1056/NEJMra1600673>. 3/31/20