Abstract
A 76-year-old African-American man who lived alone, with an 11year history of poorly controlled diabetes and symptomatic peripheral neuropathy, presented to the Emergency Department with right foot pain and swelling. His initial evaluation included a lower extremity Doppler that ruled out a deep venous thrombosis and the patient was discharged. The patient returned to the Emergency Department after one week for worsening right foot pain and swelling. He was afebrile and hemodynamically stable. The physical exam revealed new unroofed blisters on the dorsal aspect of the right foot. Foot x-ray (Panel 1) showed a 3 cm linear metallic foreign body, which appeared to be a broken sewing needle in the soft tissues between distal first and second metatarsals. Computed Tomography (CT) scan (Panel 2) showed moderate air suggesting deep tissue infection, with multiple tiny gas bubbles within the proximal phalanx of the second digit, concerning for gas gangrene. He received broad-spectrum intravenous antibiotics and underwent a two-stage operation on his right leg. The first stage was a guillotine amputation. The patient remained afebrile and hemodynamically stable. Antibiotics were stopped since now, after removal of the gangrenous tissue, there was adequate source control of the infection. A few days later, he underwent a definitive, below-theknee amputation. The differential diagnoses for gas gangrene includes inflammation
Highlights
The differential diagnoses for gas gangrene includes inflammation of any of the various tissue layers, from the skin to the deep tissues and bone such as cellulitis, deep venous thrombosis and thrombophlebitis, necrotizing fasciitis, myositis, rhabdomyolysis, or osteomyelitis [1,2]
A 76-year-old African-American man who lived alone, with an 11-year history of poorly controlled diabetes and symptomatic peripheral neuropathy, presented to the Emergency Department with right foot pain and swelling
If there is suspicion of bone infection, MRI is preferred to confirm the diagnosis of osteomyelitis [1]
Summary
The differential diagnoses for gas gangrene includes inflammation of any of the various tissue layers, from the skin to the deep tissues and bone such as cellulitis, deep venous thrombosis and thrombophlebitis, necrotizing fasciitis, myositis, rhabdomyolysis, or osteomyelitis [1,2]. In diabetic foot infections, imaging with plain films of the foot and ankle can be used to evaluate for foreign bodies, soft tissue gas, bony destruction or deformity [1]. CT is considered the imaging modality of choice when evaluating for gas or emphysematous infections.
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