Background: Appendectomies are routine procedures done with minimal complications. However, the diagnosis of acute appendicitis may be complicated by its' varied presentations. Although extremely rare, a perforated appendix is capable of causing the often fatal necrotizing fasciitis infection. Case Report: A 42-year-old hypotensive, tachycardic female with acute abdominal pain was brought to the operating room after CT findings were suspicious for acute appendicitis. Laparoscopic dissection revealed that the appendix had eroded through the abdominal wall, potentially through a hernia defect or a defect created by the infection and resulting inflammation. The appendix was removed and a drain was left in the right pericolic gutter. The patient was repositioned and a 10 cm incision was made in the right flank where a large amount of necrotic foul-smelling tissue and fluid was removed. Bacterial culture of the pus grew Peptostreptococcus and Escherichia coli. After clearing a significant amount of necrotic tissue and receiving a bedside consultation from orthopedics, the wound was packed. Conclusion: Necrotizing fasciitis is a rare, serious disease that is capable of, although very rarely, being caused by a perforated appendix. The high mortality rate associated with necrotizing fasciitis caused by appendicitis highlights the need for early diagnosis, broad-spectrum antibiotic treatment as well as timely surgical debridement to maximize chance of survival.