A 45-year-old kidney transplant recipient developed a primary varicella zoster virus infection complicated by a necrotizing bacterial superinfection of the skin and soft tissues caused by Pseudomonas aeruginosa. Progressive facial and oropharyngeal edema led to airway compromise requiring endotracheal intubation. Both blood cultures and wound cultures confirmed the growth of Pseudomonas aeruginosa. Targeted treatment with the antibiotic meropenem led to a clinical improvement in the patient's condition. The patient recovered with preserved function of the transplanted kidney, but was left with permanent facial nerve palsy. Monomicrobial necrotizing skin and soft tissue infections caused by Pseudomonas aeruginosa are rare and occur mainly in immunocompromised patients. These infections can be life-threatening.