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 <i>Staphylococcus</i> and <i>Streptococcus</i>. Monomicrobial gram-negative <i>Escherichia coli</i> (<i>E. coli</i>) 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 <i>E. coli</i> in an otherwise healthy patient. This case highlights that <i>E. coli</i> NF cannot be solely attributed to comorbidities, and physicians should be aware that NF can occur from <i>E. coli</i> infection in the absence of underlying health conditions.