Background Necrotising fasciitis is a rare, severe and potential lethal soft tissue infection. Synchronous multifocal necrotising fasciitis (SMNF) is exceedingly rare and has a mortality rate in the literature over 70%. We present a case of synchronous multifocal necrotising fasciitis (SMNF) to bilateral lower limbs in a 67-year-old-female with hypertension. The patient reported a 5-day history of pharyngitis prior to admission to a rural hospital with new onset left ankle and foot pain. Septic shock required transfer to a metropolitan hospital with ICU. On arrival, the patient was diagnosed with bilateral lower limb necrotising fasciitis, LRINEC score>8, and underwent urgent debridement and fasciotomies to both limbs. Results Debridements produced rapid clinical and biochemical improvement. All specimens grew pan-sensitive GAS and histopathology confirmed necrotising fasciitis. Development of bilateral lower limb Pseudomonas Aeruginosa infections with a Pseudomonas bacteraemia required further debridement and IV Tazocin. Procedures for dressing changes and washouts, reconstruction with BTM and skin grafting tallied over a dozen operations. Clinical photographs demonstrate the wounds and reconstruction. The patient survived. Conclusion This pathology is exceedingly rare. High clinical suspicion, urgent surgical intervention and appropriate IV antibiotics is essential to improve patient survival. With high mortality rates (over 70%), it remains a very difficult entity to treat successfully.