An Unusual Suspect in a Case of Fungal Necrotizing Soft Tissue Infection.

Necrotizing soft tissue infection (NSTI) is a rapidly progressive and potentially fatal infection that is most commonly bacterial in origin but can also be fungal. We present the case of a 79-year-old woman who developed NSTI after gastrostomy tube (G-tube) manipulation. She presented to the emergency department (ED) with abdominal pain and inflammation, and imaging revealed the G-tube to be positioned within the soft tissues. The patient then underwent emergent surgical debridement while decompensating from septic shock. Tissue cultures identified an unusual combination of Pichia and Lactobacillus species. The patient improved with repeated debridement and targeted antimicrobial therapy. This case highlights the importance of considering atypical and fungal sources of NSTI, especially in immunocompromised patients, as well as the critical nature of urgent surgical intervention.