Nontraumatic clostridial myonecrosis

Abstract

Most clostridial infections of tissue are secondary to trauma. Occasionally they may be nontraumatic or spontaneous. There are three recognizable patterns of nontraumatic clostridial tissue infections: (1) visceral anaerobic cellulitis; (2) visceral anaerobic cellulitis with contiguous spread to adjacent muscle; and (3) myonecrosis arising at a site distant from the visceral lesion. The first two patterns are not rare. The third, however, is distinctly unusual. Two cases of “distant” myonecrosis are reported, and the English literature is reviewed. The condition is uncommon and tends to affect debilitated patients and those with neoplastic disease. In most cases, ulcerative lesions of the gastrointestinal tract, especially colonic carcinoma, may allow circulatory access to clostridial bowel flora which are “seeded” to the affected muscle. Some cases may arise from spores dormant in tissue. The prognosis is poor, but early clinical recognition and prompt treatment may result in cure.