An unusual presentation of infrarenal aortoiliac occlusion with metastatic gas gangrene

Abstract

Gas gangrene is a term reserved for fulminant soft tissue infections caused by Clostridium species. The posttraumatic form of gas gangrene is caused by Clostridium perfringens. Nontraumatic, or spontaneous, gas gangrene is even more rare and is usually caused by Clostridium septicum in two-thirds of cases and by C. perfringens in one-third of cases; the underlying malignancy is often present. It also usually affects patients with some degree of underlying immunocompromised or vascular insufficiency. We report a case of a 30-year-old man with no history of prior trauma presented with pain, paresis of both lower limbs, and developed discolouration of both feet clinically diagnosed to be Leriche's syndrome with dry gangrene. Computed tomography angiography showed infrarenal aortoiliac occlusion and rapidly progressive gas gangrene involving even bladder wall and bone marrow, probably caused by Clostridium septicum. Although several case reports discuss the setting of bowel malignancy, our case illustrates acute onset of aortic iliac occlusion resulting in mesenteric infarction, which is the probable source for the infection.