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We report a case of necrotizing fasciitis and severe sepsis complicated by emphysematous gastritis. The patient initially presented with sepsis due to extensive necrotizing fasciitis. Although he recovered from severe sepsis after intensive treatment including amputation of involved lesion, fatal emphysematous gastritis developed later during long-term hospitalization. To the best of our knowledge, this is the first report on emphysematous gastritis associated with necrotizing fasciitis and sepsis.