DOI: https://doi.org/10.36347/sasjs.2026.v12i08.008

Pages: 679-686

Necrotizing dermohypodermitis and necrotizing soft-tissue infections are rare but severe surgical emergencies that require early recognition and prompt management. Their diagnosis is mainly clinical, but inflammatory, irritant or immunoallergic skin reactions may mimic necrotizing infection, particularly after topical exposure on damaged skin. We report the case of a 19-year-old male patient with no notable medical history who sustained anterolateral abrasions of the left leg after a motorcycle fall. He subsequently applied a plant-based analgesic spray directly onto the abraded skin, outside the usual conditions of use. Forty-eight hours after this application, the clinical course was marked by diffuse soft-tissue edema, violaceous ecchymotic skin discoloration and areas of early necrosis. The patient was admitted to the emergency department on day 7 with extensive necrotizing dermohypodermitis of the left leg. Laboratory tests showed marked inflammation, with a white blood cell count of 22,000/mm³ and C-reactive protein of 340 mg/L. HIV, viral hepatitis A, B and C, and syphilis serologies were negative. Management consisted of wide surgical debridement, repeated local wound care and split-thickness skin grafting at week 6. Deep bacteriological samples obtained during debridement, with no documented antibiotic treatment before sampling, were negative. The outcome was favorable, with a very good result at 1 year, despite residual dyschromia at the donor site. This case highlights the need to investigate recent topical exposure in atypical cutaneous-hypodermic necrosis while maintaining early surgical management in any severe necrotic presentation.