Invasive Group A streptococcal (GAS) disease is a clinical diagnostic and management challenge and threat to public health. Establishing the diagnosis is difficult because the presenting symptoms are not different from other less serious infections. Necrotizing fasciitis is one of the most severe manifestations of invasive GAS infection. Early detection and rapid treatment are critical to reduce the risk of mortality. This case study describes a 37-year-old male who presented to the emergency department (ED) with severe, sharp right-sided chest wall pain, which was initially diagnosed as herpes zoster by a community-based urgent care center, 3 hr prior to presenting to the ED. He was diagnosed with cellulitis and admitted for further evaluation and management. Over the next few hours, the patient's condition worsened. The patient developed septic shock and suspicion was raised for necrotizing fasciitis as the cause of the patient's illness.
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