A Disease of the Past in the Present: From Trench Foot to Critical Care With Severe Non-freezing Cold Injury

Non-freezing cold injury (NFCI), historically described as trench foot, is a rare but potentially life-threatening condition resulting from prolonged exposure to cold, wet environments at near-freezing temperatures. We present the case of a previously healthy 21-year-old man found partially submerged for three days, who developed profound hypothermia, shock, altered consciousness, and extensive soft tissue compromise. Laboratory evaluation revealed multiorgan dysfunction, and brain computed tomography (CT) demonstrated diffuse cerebral edema. Blood cultures became positive within seven hours, isolating <i>Aeromonas hydrophila</i> and <i>Pseudomonas</i> species, confirming fulminant Gram-negative bacteremia secondary to soft tissue infection. After a period of intensive supportive care, the patient improved clinically and was transferred to a burn unit for surgical management. This case highlights that NFCI is not confined to historical military contexts but remains a relevant contemporary clinical challenge. Early recognition, aggressive supportive care, and timely surgical intervention are crucial to improving survival, limiting sepsis progression, reducing tissue loss, and preventing long-term disability.