Total body necrotizing fasciitis.

Necrotizing fasciitis is uncommon in the United States. Despite medical advances, its mortality rate has remained unchanged over the past 20 years at 25% to 35%. Risk scoring tools have been created but often fall short when used in the clinical setting. We present a case of an elderly woman with necrotizing fasciitis but with extensive intraparenchymal air that is undocumented in the literature. Imaging demonstrated significant air collections originating from an infection on the right foot that extended through the body, including the cranial vault. Despite aggressive resuscitative efforts, the patient was not considered a surgical candidate and ultimately died. Using a scoring tool for our patient suggested a low probability of infection, demonstrating that clinical suspicion should take precedence over any test or scoring system.