Case Report: Necrotizing Fasciitis Involving the Bilateral Scrotum and Right Leg Caused by Streptococcus pyogenes in a Healthy Male: A Multidisciplinary Diagnostic and Therapeutic Analysis

Introduction: Necrotizing fasciitis (NF) in healthy individuals following minor trauma is rare. This represents the first documented case of bilateral scrotal and right leg NF in an otherwise healthy male, triggered by bicycle-related abrasion. It high lights a unique synergistic infection pathway involving Streptococcus pyogenes . This case expands our understanding of NF triggers in low-risk populations and underscores the role of atypical trauma in fulminant infections. Case Presentation: A 37-year-old immunocompetent male developed progressive scrotal pain and swelling following minor trauma. Included: LRINEC_score: 8 (high-risk category); CT imaging: extensive subcutaneous edema; microbiological confirmation: Streptococcus pyogenes identified via MALDI-TOFMS; and Inflammatory markers: C-reactive protein (CRP) > 300 mg/L, pro-calcitonin (PCT) > 100 ng/mL. The patient was admitted to the intensive care unit (ICU), where he received targeted antimicrobial therapy, continuous veno-venous hemofiltration (CVVH), and high-dose immunoglobulin shock therapy. Within 72 hours, the surgical team performed fasciotomy and vacuum-assisted closure. Antibiotic therapy was adjusted to penicillin based on pathogen susceptibility results. The patient achieved full functional recovery at six-month follow-up. Conclusions This case underscores that NF can arise from seemingly trivial injuries, even in low-risk populations. Early diagnosis relies on LRINEC scoring combined with imaging. Time-critical multidisciplinary team (MDT) collaboration, with immediate coordination for pathogen identification within 24 hours and urgent surgical debridement within 72 hours, is crucial for survival. Standardized post-trauma infection screening and MDT protocols should be emphasized in primary care settings.