Necrotizing Myositis Caused by Enterococcus faecium with Concurrent Klebsiella pneumoniae Bacteremia: A Rare Case Report.

We present a rare case of necrotizing myositis predominantly caused by Enterococcus faecium in a 68-year-old healthy man, with concurrent Klebsiella pneumoniae bacteremia. The patient rapidly progressed from diarrhea and fever to septic shock, multiple organ dysfunction, and compartment syndrome of the left leg. Blood cultures grew K. pneumoniae, while deep tissue cultures identified E. faecium as the main pathogen in necrotic muscle. Emergent fasciotomy, serial debridements, and targeted antibiotics (meropenem and linezolid/vancomycin) led to full recovery. This first reported case highlights the underappreciated virulence of E. faecium in soft tissue infections and underscores the need for prompt imaging, surgical intervention, and comprehensive microbiological workup in severe infections. The case also emphasizes the importance of considering polymicrobial etiology and monitoring for antibiotic adverse effects.