title: Escherichia coli myonecrosis in alcoholic cirrhosis.
abstract: The risk of bacteremia in patients with cirrhosis increases with more advanced Child classification. Escherichia coli is the most frequently implicated organism in these bacteremic episodes. Unusually, E. coli can produce a bullous cellulitis or myonecrosis. Two previous cases of E. coli-associated myonecrosis in patients with cirrhosis have been reported. We describe a third case in a cirrhotic patient with E. coli-associated bilateral lower extremity gas gangrene and review the existing literature. In the three patients with cirrhosis and E. coli myonecrosis, no obvious gastrointestinal perforation was found as the source of bacteremia. Intestinal edema due to portal hypertension is thought to have facilitated mucosal microperforations and bacteremia. Awareness of this unusual presentation may facilitate earlier diagnosis.
authors.affiliation: Stanford University School of Medicine, Division of Infectious Diseases and Geographic Medicine, California 94305, USA. vlevy@stanford.edu
authors.forename: Vivian
authors.initials: V
authors.lastname: Levy
authors.forename: Catherine
authors.initials: C
authors.lastname: Reed
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Abbott
authors.forename: Dennis
authors.initials: D
authors.lastname: Israelski
mesh_terms: D016470:Bacteremia / Q000382:microbiology; D004927:Escherichia coli Infections / Q000209:etiology*; D017809:Fatal Outcome; D005738:Gas Gangrene / Q000473:pathology; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000382:microbiology / Q000473:pathology*; D009336:Necrosis