Fulminant Myonecrosis From a Minor Puncture Wound Leading to Hip Disarticulation: A Rare Case of Clostridium septicum Gas Gangrene

Abstract

A 60-year-old gentleman presented to the emergency room after stepping on a nail. He received a tetanus toxoid injection and was discharged. Ten days later, there was insidious onset of right upper thigh soreness which within a few hours, rapidly progressed to excruciating pain with associated lower extremity swelling. The patient presented to the Emergency Department in a state of acute delirium. Clinical examination revealed discoloration, swelling, and crepitation over the right thigh. Computed tomography (CT) scan of the pelvis and lower extremities confirmed “subcutaneous air” in muscular and fascial planes. He was transferred to the operating room emergently. Necrotic, nonviable muscle groups in the region of the vastus lateralis, intermedius, and medialis muscles, as well as the sartorius were excised. The debridement was carried down to the femur and superiorly to the iliac crest and inguinal ligament. Right hip disarticulation followed by ligation of right external iliac artery and vein was performed. Clostridium septicum septicemia is rapidly progressive and often fatal within 12 h of initial presentation. Characteristic signs and symptoms include fever, tachycardia which is often out of proportion to the fever, tenderness, hypotension, nausea, and vomiting. Palpable crepitation due to soft tissue gas production in the limb is unusual but when present, as it was in our case, is suggestive of the diagnosis. Despite a rapid and often a fatal clinical course leading to death within 12 - 24 h, cures have been reported following prompt administration of high dose antibiotics and aggressive surgical debridement. Antitoxin and hyperbaric oxygen are of uncertain benefit.

Clin Infect Immun. 2020;5(3):66-70
doi: https://doi.org/10.14740/cii105