Nonclostridial necrotizing soft-tissue infections are usually polymicr
obial, with greater than 90 per cent involving P-hemolytic streptococc
i or coagulase-positive staphylococci. The remaining 10 per cent are u
sually due to Gram-negative enteric pathogens. We describe the case of
a 46-year-old woman with bilateral lower extremity fungal soft tissue
infections. She underwent multiple surgical debridements of extensive
gangrenous necrosis of the skin and subcutaneous fat associated with
severe acute arteritis. Histopathological examination revealed Aspergi
llus niger as the sole initial pathogen. Despite aggressive surgical d
ebridement, allografts, and intravenous amphotericin B, her condition
clinically deteriorated and she ultimately died of overwhelming infect
ion. Treatment for soft-tissue infections include surgical debridement
and intravenous antibiotics. More specifically, Aspergillus can be tr
eated with intravenous amphotericin B, 5-fluorocytosine, and rifampin.
Despite these treatment modalities, necrotizing fascitis is associate
d with a 60 per cent mortality rate. Primary fungal pathogens should b
e included in the differential diagnosis of soft-tissue infections.