Misdiagnosis of soft tissue infections: clinical pitfalls and management implications.

INTRODUCTION: Skin and soft tissue infections (SSTIs) are among the most frequent reasons for medical evaluation worldwide and are associated with significant clinical and healthcare-related implications. However, their diagnosis remains challenging, with frequent misdiagnosis, including both overdiagnosis of uncomplicated cellulitis and under-recognition of life-threatening necrotizing soft tissue infections. AREAS COVERED: We conducted a narrative review of the literature on diagnostic challenges in SSTIs. A search of PubMed/MEDLINE was performed for studies published up to March 2026, focusing on the misdiagnosis of cellulitis and necrotizing infections. We examined factors contributing to diagnostic errors, as well as the role of clinical assessment, laboratory tests, imaging, and multidisciplinary approaches in improving diagnostic accuracy and patient outcomes. EXPERT OPINION: Improving diagnostic accuracy in SSTIs requires structured clinical pathways based on careful assessment, early reassessment, and the selective use of imaging and specialist consultation. Future advances are more likely to derive from integrated diagnostic frameworks than from single diagnostic tests.