We present three patients, two men (aged 30 and 75 years), and one woman (aged 22 years), who were treated in our hospital for severe necrotizing soft tissue disease. One patient died within the first hour of reaching the hospital. The other two patients underwent emergency surgical resection of affected tissue, of which one died of septic shock with multi-organ failure. Severe necrotizing soft tissue disease is a rare group of infections characterized by extensive fulminant necrosis of soft tissue, severe systemic toxicity, and a high mortality rate. A key clinical feature is a marked discrepancy between the severity of pain perception and local findings. Treatment consists of extensive, often-repeated surgical debridement, antimicrobial therapy, fluid resuscitation, and cardiopulmonary support. Early diagnosis and surgical treatment are essential for survival. Copyright © 2011, Nederlandse Vereniging voor Intensive Care.