Fig. 1

Synchronous multifocal Vibrio spp. necrotizing fasciitis on both lower limbs in a 60-year-old fisherman with multiple comorbidities: liver cirrhosis and end-stage renal failure. a An acute onset of intractable pain, swelling, purpura, and hemorrhagic bullae occurred in both feet on the second day after saltwater exposure. b The swollen and purpuric lesions with out of proportion pain were rapidly worsening and extending to both thighs. c and d. Loss of resistance of normal adherent superficial fascia to gentle finger dissection was found. Immediate fasciotomies on both lower limbs revealed foul-smelling fluid. The patient died of uncontrolled sepsis 4 days after the onset of synchronous multifocal necrotizing fasciitis