A 58-year-old Caucasian woman was admitted for knee replacement but during the postoperative period she developed sepsis due to pneumonia, which was treated with coamoxiclav and then piperacillin (for 2 weeks). She had renal failure, which needed haemofiltration. During her recovery she had diarrhoea due to Clostridium difficile, which was not controlled with metronidazole. Vancomycin was therefore given, but she developed urticarial erythematous skin rash and hence it was stopped. She was not on any other new medications and a vasculitic screen was negative. A dermatologist reviewed her file as well. The skin rash subsided after 2 weeks with topical emollients and chlorphenamine tablets. Her diarrhoea eventually settled and she went home well. Though classically described in men, this "red man" syndrome (features of urticarial erythematous rash due to oral vancomycin) has been previously reported in case reports and in literature reviews.

We report a case of diabetic foot gangrene that was treated with homeopathic therapy which avoided a need for amputation of the limb. From this case report, we would like to suggest that there are better options like homeopathic therapy for a patient with diabetic foot gangrene rather than considering them for the amputation.

Fungal necrotizing fasciitis (NF), particularly in the face, is an unusual infection. It is mostly seen in immunocompromised individuals and can be gravely destructive if diagnosis and treatment are delayed. We report this rare case of a 27-year-old, immunocompetent male who presented with gangrenous patch of skin on the cheek following blunt trauma to the right side of the face. Till now no case has been reported in literature with such an extensive soft tissue loss of face and involvement of facial skeleton due to fungal etiology. Clinical suspicion of necrotizing fasciitis led to early surgical intervention. Histopathological examination of the debrided tissue identified the infective organism as Apophysomyces elegans. Intravenous antifungal therapy with liposomal amphotericin B was initiated. Despite the prompt commencement of the treatment, the infection continued to spread, and the patient had to undergo serial debridement which resulted in orbital exenteration, partial maxillectomy and mandibulectomy on the right side. This resulted in a huge soft tissue defect requiring flap cover. A free anterolateral thigh flap was harvested to cover the soft tissue defect, but the blood flow could not be established. For salvage, scalp and pectoralis major muscle flaps were raised and used to cover the large hemifacial defect. The oral lining was created with a folded deltopectoral flap in a second stage. However, there was persistence of the fungal elements in wound bed even after prolonged systemic liposomal amphotericin B therapy and it invaded the flap margins due to which there was partial necrosis of the flap. In this article, we aim to describe the difficulties faced by us in the management of such devastating infection and the reconstructive challenge that it posed.