Fatal Necrotizing Fasciitis Caused by Pasteurella multocida Without Cutaneous Findings: When Pain Is the Clue

We report a case of fatal necrotizing fasciitis in an elderly woman presenting with severe right upper-arm pain and elevated inflammatory markers in the absence of apparent skin changes or diagnostic imaging findings. Despite broad-spectrum antimicrobial therapy and supportive care, the patient deteriorated rapidly and died within 24 hours of hospital admission. Post-mortem blood cultures identified <i>Pasteurella multocida</i>, a zoonotic pathogen commonly found in cats and dogs. Retrospective review of the initial CT scan revealed fascial edema and soft tissue stranding, compatible with necrotizing fasciitis. Necrotizing fasciitis caused by <i>P. multocida</i> is exceedingly rare, particularly in the absence of skin disruption or penetrating injury. Close contact with household animals can enable non-bite transmission. This case highlights an important diagnostic pitfall: severe, localized pain out of proportion to physical findings may be the only early clinical sign of necrotizing fasciitis. Clinicians should remain vigilant for deep soft-tissue infection in septic patients presenting with disproportionate pain, as early recognition, interdisciplinary management, and prompt surgical intervention are essential to improve outcomes.