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Necrotising fasciitis — MCCQE Part 1 MCQ

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HardRashNecrotising fasciitisMCCQE Part 1

A 58-year-old woman with diabetes presents with rapidly worsening leg pain after a minor scratch. She is febrile and confused. The calf is swollen with violaceous skin, bullae, crepitus, and pain beyond the erythematous area. What is the most appropriate next step in management?

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Correct answer: C — Start broad-spectrum intravenous antibiotics and urgent surgical debridement

Pain out of proportion, systemic toxicity, bullae, crepitus, and rapid progression indicate necrotising soft tissue infection, requiring immediate broad-spectrum antibiotics and surgical debridement. Oral cellulitis treatment is inadequate. MRI may help in equivocal cases but should not delay surgery when the diagnosis is clinically compelling. Compression and topical therapy are unsafe.

Reference: Association of Medical Microbiology and Infectious Disease Canada soft tissue infection guidance