Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 2 3 2018 01 16 e37 e37 Mahbube Ebrahimpur Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mahnaz Pejman-Sani Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Neda Alijani Department of Infectious Diseases, Shariati hospital, Tehran University of Medical Science, Tehran, Iran. 2018 02 16 Case presentation: A 46-year-old man was admitted to the emergency department with complaints of fever and skin lesions in the right leg since 3 days before. Moreover, he revealed a history of 5 years of poorly controlled diabetes mellitus despite being on oral medication. On physical examination, he was oriented and the following vital signs were observed: blood pressure: 80/60 mmHg; pulse rate: 90 beats/min; respiratory rate: 18 breaths/min; and oral temperature: 38 °C. Two large erythematous lesions with central necrosis in the upper segment of the right leg were noticed. Further examination revealed crepitation of the same right leg segment. Laboratory findings revealed the following: white blood cell (WBC) count, 17,000/mm3; hemoglobin, 15 g/dl; sodium, 125 meq/l; potassium, 3.8 meq/l; blood glucose, 400 mg/dl; blood urea nitrogen, 45 mg/dl; creatinine, 2.4 mg/dl; and bicarbonate,13 meq/l. Plain X-ray of right leg revealed gas formation in the soft tissues, which was a diagnostic criterion for necrotizing fasciitis (Figure 1). The patient was treated immediately with intravenous fluid, broad spectrum empiric antibiotics (meropenem plus vancomycin), and insulin infusion; moreover, urgent surgical consultation was requested. He underwent emergency debridement within few hours of hospitalization. https://fem.tums.ac.ir/index.php/fem/article/view/59 https://fem.tums.ac.ir/index.php/fem/article/download/59/57