Clostridium septicum myonecrosis presenting as an acute painful foot.
Spontaneous clostridial myonecrosis (gas gangrene) is an uncommonly encountered presentation of skin and soft-tissue infections with high morbidity and mortality. The diagnosis has been associated with colorectal carcinoma, hematologic malignancies, and diabetes. We report the case of an 81-year-old man who experienced a sudden onset of left ankle and foot pain in association with nonpalpable purpura and hemorrhagic bulla. The diagnosis was initially suspected on clinical presentation, gas in tissue on plain-film radiography, and Gram staining of aspirated bulla contents. Cultures grew Clostridium septicum, and a large cecum mass was found by computed tomography of the abdomen. A subsequent right hemicolectomy confirmed a well to moderately differentiated mucinous adenocarcinoma. We emphasized that the early recognition of necrotizing skin and soft-tissue infections warrants further evaluation and appropriate management.
Division of Infectious Diseases, Department of Medicine, University of Kentucky College of Medicine, A.B. Chandler Medical Center, Lexington, KY 40536-0298, USA. william.wright@uky.edu
William F
WF
Wright
D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D052557:Clostridium septicum; D004636:Emergency Service, Hospital; D005528:Foot / Q000382:microbiology / Q000473:pathology*; D005534:Foot Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology; D005738:Gas Gangrene / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D006801:Humans; D008297:Male; D009336:Necrosis; D010146:Pain / Q000209:etiology*
D000900:Anti-Bacterial Agents