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 Pasteurella multocida, 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 P. multocida 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.