title: Gas gangrene pyaemia with myocardial abscess formation--fatal outcome from a rare infection nowadays.
abstract: We report a case of sudden death after gas gangrene. A 67-year-old male patient with diabetes mellitus and chronic renal failure (on haemodialysis three times a week) presented in the surgical emergency department with a severe swelling and crepitation in the right groin. No signs of trauma were present-except for a well-healed, 1-year-old scar after femoro-popliteal bypass surgery. Two days earlier, he had presented to the internal medicine department with epigastric pain and had left against medical advice. On readmission the patient was initially conscious and in a stable cardiopulmonary condition but developed sudden cardiocirculatory failure and underwent resuscitation. Despite all resuscitation measures, including the administration of high doses of catecholamines and the treatment of hyperkalemia, the patient died. Autopsy revealed septicaemia with rod-shaped gram-positive bacteria, typical of Clostridium perfringens, evidenced by multiple areas of myonecrosis. Abscess formation was found in the myocardium. Clostridial gas gangrene is a rare clinical condition. Unless immediate diagnosis and adequate therapy measures are taken, the outcome and chances for survival are poor as demonstrated by this case.
authors.affiliation: Department of Surgery, University Hospital of Mannheim, 68135 Mannheim, Germany. michael.keese@chir.ma.uni-heidelberg.de
authors.forename: Michael
authors.initials: M
authors.lastname: Keese
authors.forename: Thomas
authors.initials: T
authors.lastname: Nichterlein
authors.forename: Matthias
authors.initials: M
authors.lastname: Hahn
authors.forename: Richard
authors.initials: R
authors.lastname: Magdeburg
authors.forename: Mevlut
authors.initials: M
authors.lastname: Karaorman
authors.forename: Walter
authors.initials: W
authors.lastname: Back
authors.forename: Jörg
authors.initials: J
authors.lastname: Sturm
authors.forename: Heinz
authors.initials: H
authors.lastname: Kerger
mesh_terms: D000038:Abscess / Q000209:etiology* / Q000473:pathology; D000368:Aged; D009202:Cardiomyopathies / Q000209:etiology* / Q000473:pathology; D016887:Cardiopulmonary Resuscitation; D005738:Gas Gangrene / Q000150:complications* / Q000401:mortality / Q000473:pathology; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D008297:Male; D012772:Shock, Septic / Q000209:etiology* / Q000473:pathology