Conclusions:
This case demonstrates a rare presentation of an angioinvasive dermatophyte necrotizing soft tissue infection in the setting of hematologic malignancy and increasing immunosuppression. In patients with superficial dermatophyte infections, immunosuppression may predispose to deeper infection and potentially angioinvasive disease. If superficial dermatophyte lesions appear dusky with pain out of proportion to exam, early biopsy should be pursued to assess for deeper invasion. Early and aggressive surgical debridement with assessment and washout of the fascial compartments can halt progression of necrotizing soft tissue infections and result in limb salvage. This case additionally adds to the paucity of literature on management strategies of angioinvasive dermatophyte infections which included surgical debridement, reduction of immunosuppression, and a 12-week course of oral terbinafine 250 mg daily.