A case of necrotizing fasciitis with a LRINEC score of zero: clinical suspicion should trump scoring systems

J Emerg Med. 2013 May;44(5):928-31. doi: 10.1016/j.jemermed.2012.09.039. Epub 2012 Dec 31.


Background: Necrotizing fasciitis (NF) is a potentially lethal infection involving the skin, subcutaneous tissue, and fascia. The Laboratory Risk Indicator for Necrotizing fasciitis (LRINEC) score has been proposed as a way of using abnormal laboratory values to distinguish between severe cellulitis and necrotizing fasciitis.

Objectives: The utility of the LRINEC system, including a review of current literature on this scoring system, is discussed.

Case report: A case of a 37-year-old man is presented. As part of the diagnostic work-up, appropriate laboratory tests necessary to calculate a LRINEC score were obtained. Despite a LRINEC score of 0, NF was later confirmed at surgery.

Conclusions: Although the LRINEC score has been proposed as a robust way of identifying patients with early NF, it failed to detect NF in the patient reported here. NF should thus remain primarily a disease of clinical suspicion, and this suspicion should trump the LRINEC score.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Blood Glucose / analysis
  • C-Reactive Protein / analysis
  • Creatinine / analysis
  • Emergency Service, Hospital
  • Fasciitis, Necrotizing / diagnosis*
  • Fasciitis, Necrotizing / microbiology
  • Fasciitis, Necrotizing / therapy
  • Hemoglobins / analysis
  • Humans
  • Lactic Acid / blood
  • Leukocyte Count
  • Male
  • Risk Assessment / methods*
  • Sodium / analysis
  • Tomography, X-Ray Computed


  • Blood Glucose
  • Hemoglobins
  • Lactic Acid
  • C-Reactive Protein
  • Sodium
  • Creatinine