title: Gas gangrene from subcutaneous insulin administration.
abstract: A case of gas gangrene that caused intractable shoulder pain refractory to narcotics in an immunocompromised host is presented. Gas gangrene has been associated with severe trauma involving penetrating wounds, compound fractures, extensive soft-tissue injury, intramuscular injection of epinephrine, and interruption of arterial blood supply. This case describes an elderly insulin-dependent diabetic woman who developed gas gangrene in her arm and leg at the site of her subcutaneous insulin injections. The responsible organism was Clostridium septicum. Emergency medicine physicians must consider gas gangrene Clostridium infection in immunocompromised individuals without evidence of trauma who present with localized and intractable pain.
authors.affiliation: Stanford/Kaiser Emergency Medicine Residency Program, Stanford University Hospital, Palo Alto, CA.
authors.forename: R L
authors.initials: RL
authors.lastname: Chin
authors.forename: R
authors.initials: R
authors.lastname: Martinez
authors.forename: G
authors.initials: G
authors.lastname: Garmel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D017809:Fatal Outcome; D005260:Female; D005738:Gas Gangrene / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D006801:Humans; D016867:Immunocompromised Host; D007279:Injections, Subcutaneous / Q000009:adverse effects*; D007336:Insulin, Isophane / Q000008:administration & dosage*; D010148:Intractable Pain / Q000188:drug therapy / Q000209:etiology*; D011859:Radiography; D012782:Shoulder; D013848:Thigh
chemical_list: D007336:Insulin, Isophane