Background In contrast to Fournier gangrene which is a polymicrobial infection prone to patients with comorbidities, the emergence of a community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA)-induced, monomicrobial perineal necrotizing fasciitis involving relatively healthy female patients have been noted.

Aim & Objectives Our aim is to investigate the initial presentation of CA-MRSA perineal necrotizing fasciitis at the Emergency Room (ER), its definitive diagnosis, and treatment protocols including antibiotic use and surgical intervention.

Materials & Methods Three cases of this rare type of perineal necrotizing fasciitis were encountered at Yuan’s General Hospital from 2014 to 2017. Patients involved were relatively healthy, with no history of diabetes mellitus, chronic renal failure, or liver disease. Initial presentations at the ER included erythematic skin lesion and swelling in the perineum region with extension toward the low abdomen which were common findings, and elevated white blood cell count and C-reactive protein. Serial debridement with wound culture was arranged once perineal necrotizing fasciitis was diagnosed. Soft tissue defects were reconstructed with local advancement flaps.

Results All bacterial cultures revealed MRSA, possibly community acquired. And all patients were discharged uneventfully after treatment.

Conclusion Despite its rarity and drug-resistant nature, CA-MRSA-induced perineal necrotizing fasciitis can be well-controlled by keeping a high alert at the ER, followed by timely antibiotic use and surgical intervention.

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