Background: Diffuse extremity vascular malformation as a source of severe lower limb pain in the setting of septic shock and pneumonia has not been described in the literature. Such a presentation would naturally arouse suspicion of necrotizing fasciitis. Case report: Our patient is a teenager with a history of extensive right lower limb vascular malformation with previous multiple sclerotherapies. He presented with septic shock secondary to right upper zone pneumoniae. There was also severe right leg pain which was initially diagnosed as necrotizing fasciitis. This was later found to be due to increase bloodflow through his vascular malformation. In this report, we share such a case discussing some distinctive features and mechanisms. Conclusion: Pain from increased flow and vasodilation is an important feature of extremity vascular malformations. This can be from exercise, trauma or even fever. This leads to engorgement of the blood vessel which then brings about pain, which is often a heavy, bursting-like feeling similar to that in chronic venous insufficiency.
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