Abstract
Diabetic myonecrosis with Clostridium Septicum is uncommon but carries a high mortality rate. This commensal organism is part of the gastrointestinal tract flora and can become extremely virulent, often in the setting of immuno-suppression such as neutropenia, occult malignancy (commonly caecal) and poorly controlled diabetes. The case report is unusual in that there are few risk factors other than very mild neutropenia. This highlights the opportunistic character of the organism and recommends that a high index of suspicion and vigilance be carried out in the presence of fevers and sepsis, even in the well-controlled diabetic population.
Highlights
The case reports a unique and peculiar condition of extensive and fatal Clostridium Septicum myonecrosis in a diabetic patient undergoing chemotherapy for her breast cancer
Contrary to previous reports where the common risk factors are poorly controlled diabetes, severe neutropenia and classically caecal carcinoma, a sanctuary for the bacillus, our patient had only mild and asymptomatic neutropenia. Another notable risk factor was morbid obesity in the patient which confers a general increase in all-risk mortality
The only diabetes complication included mild background non-proliferative retinopathy which has been observed. Her breast cancer was diagnosed 6 months prior with grade 3 intraductal carcinoma with axillary metastasis requiring mastectomy with axillary clearance followed by systemic adjuvant chemotherapy with Adriamycin and Cyclophosphamide
Summary
The case reports a unique and peculiar condition of extensive and fatal Clostridium Septicum myonecrosis in a diabetic patient undergoing chemotherapy for her breast cancer. Contrary to previous reports where the common risk factors are poorly controlled diabetes, severe neutropenia and classically caecal carcinoma, a sanctuary for the bacillus, our patient had only mild and asymptomatic neutropenia. No history of trauma was noted to the area Her past medical history included type 2 diabetes of eight years with reasonable control, requiring Metformin 1 gm twice daily. Her home daily glucose readings oscillated between ~5–7 mmol/L in the previous 6–8 weeks, with a HbAc1 of 6.5% two weeks prior. The only diabetes complication included mild background non-proliferative retinopathy which has been observed Her breast cancer was diagnosed 6 months prior with grade 3 intraductal carcinoma with axillary metastasis requiring mastectomy with axillary clearance followed by systemic adjuvant chemotherapy with Adriamycin and Cyclophosphamide.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
