Fulminant Endogene Gas Gangrene in a Previously Healthy Male

Zelić, Marko; Vukas, Duje; Valković, Petra; Kovač, Dražen; Šustić, Alan; Rukavina, Tomislav

doi:10.1080/00365540410020307

Cited by 5 publications

(7 citation statements)

References 8 publications

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“…2,3 C septicum, an anaerobic Gram-positive rod, is the causative organism in the majority of cases, followed by Clostridium perfringens. 4,5 Unlike typical cases of gas gangrene, which follow trauma and are caused by C perfringens, the majority of cases of spontaneous gas gangrene have no obvious external portal of entry. The presumed source is mucosal defects of the intestinal tract.…”

Section: Discussionmentioning

confidence: 99%

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Clostridial Myonecrosis in an Adolescent Male

Langhan

Arnold

2005

Pediatrics

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ABSTRACT. Extremity pain is a common complaint in adolescents. Pain out of proportion to examination findings should raise suspicion of deep tissue infection. Clostridial myonecrosis is a rapidly progressive disease consisting of muscle necrosis and systemic toxicity. It is usually seen in elderly and immunocompromised patients. Here we report a case of clostridial myonecrosis in an adolescent male. C lostridial myonecrosis is a rare disease in the United States, with an estimated incidence of 900 to 1000 cases per year. 1 However, its virulent course and high mortality rate necessitate a high degree of suspicion among treating physicians. Here we present a case in an otherwise healthy teenager and a review of the recent literature. CASE REPORTA previously healthy 17-year-old male presented to the emergency department with a 2-day history of bilateral leg pain. The day before admission he was seen by his pediatrician and found to have fever, facial swelling, and oral ulcers. He was diagnosed with a presumptive viral illness and treated with supportive measures. He returned the next day with increasingly severe leg pain, and additional evaluation was undertaken.His past medical history consisted of a diagnosis of EpsteinBarr virus 1 month before presentation from which he still complained of fatigue. He had done some light weight-lifting several days before the onset of pain but had no recent participation in organized sports activities. There was no history of trauma, and he denied drug or steroid use.His initial vital signs were notable for a temperature of 39.1°C, respiratory rate of 32 breaths per minute, heart rate of 132 beats per minute, and a blood pressure of 141/62 mm Hg. He was pale, diaphoretic, and unable to stand secondary to his pain. Mild orbital edema was present as well as gingival swelling and a single oral ulceration. There was severe tenderness involving both of his thighs and his right calf muscles.Urinalysis revealed hematuria and proteinuria and the absence of red blood cells. Blood counts showed a white blood cell count of 2700/L (57% bands, 5% segmented neutrophils, 13% lymphocytes, 19% monocytes), and his creatine phosphokinase was elevated at 3594 IU/L. His electrolytes and coagulation profile were within normal limits. The erythrocyte sedimentation rate was 42 mm/hour.Despite intravenous hydration and multiple doses of morphine and ketorolac, there was no improvement in the patient's pain, and he was admitted to the hospital with a presumptive diagnosis of viral myositis for pain control, continued hydration, and monitoring of renal function. Within 2 hours of admission, he developed a violaceous rash over his legs and became hypotensive. On examination, he was noted to have subcutaneous emphysema in both lower extremities. His legs were noted to be markedly enlarged, and distally they were cool and pale. The symptoms soon spread to involve his right arm. Surgery was consulted and an emergent computed tomography scan was obtained, which showed gas extending from his calves to his psoa...

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Section: Discussionmentioning

confidence: 99%

“…8,9 Spontaneous gas gangrene has a particular association with colon cancer. 3,4,10 In 1 review of spontaneous C septicum infections, 34% of the patients were found to have colorectal cancer, and 40% were found to have a hematologic malig- …”

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Clostridial Myonecrosis in an Adolescent Male

Langhan

Arnold

2005

Pediatrics

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“…2 It occurred spontaneously in only 16% of cases and this form is typically caused by C. septicum. 1,3,4 Although C. perfringens is the most common cause of gas gangrene, C. septicum is the dominant species associated with malignancy, diabetes mellitus, and immunosuppression. [5][6][7][8][9] It is believed that Clostridia gain access to the bloodstream after colonising the mucosa of the large bowel, 10 then spread via the bloodstream to skeletal muscle, causing myonecrosis.…”

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confidence: 99%

“…The diagnostic criteria of HLH proposed by the FHL study group of the Histiocyte Society in 1991, 4 include clinical, laboratory, and histopathologic features. The most common signs are fever and splenomegaly, but hepatomegaly, lymphadenopathy, jaundice, rash and central nervous system manifestations are also seen.…”

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confidence: 99%

“…Most patients have hypertriglyceridemia, elevation of lactate dehydrogenase and marked elevation of ferritin. 1,4 Histopathologically, hemophagocytosis is seen in bone marrow, spleen, lymph nodes, and occasionally the central nervous system and skin. Our patient had an abnormal coagulation profile, elevated liver enzyme activities, high triglyceride levels, low…”

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Spontaneous, nontraumatic gas gangrene due to Clostridium perfringens

Yıldız

Gündeş²,

Willke³

et al. 2006

International Journal of Infectious Diseases

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Spontaneous Clostridium perfringens Myonecrosis of the Shoulder

Lanting

Athwal²,

Naudie³

2007

Clinical Orthopaedics &Amp; Related Research

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Clostridium perfringens is a rare, life-threatening infection. We present an atypical evolution of spontaneous Clostridium perfringens myonecrosis in a monitored healthy patient. After a head injury, the hemodynamically stable patient became febrile and grew cultures of Clostridium perfringens with no identifiable focus. Antibiotics were initiated. Seventy-two hours after culture results, the patient complained of shoulder pain and imaging revealed periscapular subcutaneous emphysema. Multiple surgical débridements of the necrotic supraspinatus muscle were required to eradicate the infection. The unique features of this patient include the opportunity to (1) follow the progression of clostridial myonecrosis in a healthy patient in a monitored setting and (2) study the extended period of time between positive cultures and the onset of clinical myonecrosis, a feature at odds with the classic rapid progression.

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Fulminant Endogene Gas Gangrene in a Previously Healthy Male

Cited by 5 publications

References 8 publications

Clostridial Myonecrosis in an Adolescent Male

Clostridial Myonecrosis in an Adolescent Male

Spontaneous, nontraumatic gas gangrene due to Clostridium perfringens

Spontaneous Clostridium perfringens Myonecrosis of the Shoulder

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