Spontaneous Clostridium septicum Septic Arthritis of the Shoulder and Gas Gangrene

Abstract

S pontaneous Clostridium septicum gas gangrene is a rare, devastating disease associated with a high mortality rate, even with treatment1-3. Rapid soft-tissue destruction and gas formation followed by septicemia and multiorgan failure is the usual clinical course. Another rare manifestation of Clostridium septicum infection is septic arthritis. We describe what we believe is the first reported case of concurrent Clostridium septicum gas gangrene and septic arthritis. The patient's family was informed that data concerning the case would be submitted for publication. A seventy-six-year-old man presented to a local accident and emergency department with the sudden onset of pain in the left shoulder. The pain had begun fourteen hours previously with no precipitating injury. There was no history of shoulder problems; current medical problems included non-insulin-dependent diabetes mellitus and ischemic heart disease. On examination, an area of skin discoloration, approximately 15 × 10 cm in size, was seen around the outer aspect of the left upper arm and was thought to be bruising. To rule out the possibility of an occult fracture of the humerus, a radiograph was made, and it demonstrated widespread gas in the subcutaneous tissues of the arm and lateral chest wall (Fig. 1). Reexamination of the arm revealed surgical emphysema and extension of the discolored area. A presumptive diagnosis of necrotizing fasciitis was made, and a broad-spectrum antibiotic (imipenem-cilastatin) …