Nontraumatic Clostridial Myonecrosis Research Articles

Nontraumatic Clostridial Myonecrosis: An Indication for Colonoscopy?

Clostridial myonecrosis (CM) is a rare infection that usually arises after traumatic injury. Spontaneous or nontraumatic CM is even more rare and has been described in association with colorectal malignancy. These infections carry a high mortality rate and require urgent surgical intervention and intensive antibiotic therapy. This report describes a patient who presented with nontraumatic CM of the lower extremity in association with adenocarcinoma of the cecum.

Nontraumatic Gas Gangrene

A 77-year-old man with a history significant only for coronary artery disease presented to the ED with left-arm pain, shortness of breath, nausea, and diaphoresis. Six hours after the patient's admission to the hospital for presumed unstable angina, fever and left arm swelling, associated with crepitus and violaceous bullae, developed. The patient was taken to the operating room, where he was found to have extensive myonecrosis requiring forequarter amputation of the left arm. Nontraumatic clostridial myonecrosis is a fulminant, often fatal infection. This rare condition is usually caused by Clostridium septicum and has a high association with underlying malignancy. The patient reported here was found to have a colonic lesion and acute leukemia, both previously undiagnosed. This case illustrates the insidious manner in which spontaneous myonecrosis may present. [Valentine EG: Nontraumatic gas gangrene. Ann Emerg Med July 1997;30:109-111.]

Spontaneous Clostridial Myonecrosis

Spontaneous, nontraumatic clostridial myonecrosis is a rare infection with an insidious onset and usually fatal outcome. Spontaneous clostridial myonecrosis has a frequent association with colon carcinoma, leukemia, diabetes mellitus, and drug-induced immunosuppression. We present the case of a 73-year-old diabetic man who died of spontaneous Clostridium septicum myonecrosis, who had presented with fulminant gangrene of the right thigh. Clostridium septicum was cultured from the quadriceps muscle postmortem. At autopsy, in addition to the gangrene, there was a Duke's A adenocarcinoma of the cecum, which had not been diagnosed during life. When spontaneous nontraumatic clostridial myonecrosis is diagnosed at autopsy, investigation should include through exam and the obtaining of past medical history in order to elucidate predisposing factors.

Clostridia: An Alternative Cause of 'Ethylene Dibromide' Fatalities-Reply

In Reply.— We were aware of the correspondents' alternative theory on the cause of death for the two workers described in our article. However, we concluded that this alternative explanation was medically and scientifically untenable on the following grounds. The first worker died 13 hours after he collapsed inside the tank. To describe a death secondary to tissue invasion by clostridial species in a previously healthy adult in this time frame is implausible; there are no cases described in the literature that would support such a hypothesis. Furthermore, the patient had no evidence of pneumonia by symptoms, blood gas values, or chest x-ray films. Previous case reports of nontraumatic clostridial myonecrosis have always occurred in patients with serious predisposing factors such as malignant disorders, perforated hollow viscus, or previous parenteral administration of certain clostridial species in contaminated medications. 1,2 No published data support the only possible primary route of entry

Non-traumatic clostridial myonecrosis. Report of two cases.

Non-traumatic clostridial myonecrosis. Report of two cases.

Nontraumatic clostridial myonecrosis: An infectious disease emergency

A 64-year-old man presented with a history of four days of lower abdominal pain and 12 hours of cutaneous discoloration, bullae formation, and swelling of the soft tissues of abdominal wall and right thigh. Myonecrosis of abdominal wall and an adenocarcinoma of the cecum were found at operation. Cultures of blood and fluid from the bullae yielded Clostridium septicum. Nontraumatic clostridial myonecrosis is a fulminant, usually fatal disease that is most often the result of bacteremia from an occult gastrointestinal lesion. Ulceration of the colon or terminal ileum is the most common predisposing condition, and is usually due to gastrointestinal or hematological malignancy. Patients often present with nonspecific complaints, including pain at the affected site and fever. The disease progresses rapidly to include bronze discoloration, edema, and hemorrhagic bullous lesions of the skin, subcutaneous emphysema, and myonecrosis. Presumptive diagnosis often can be made by Gram stain of the bullous fluid that reveals gram-positive bacilli and a paucity of leukocytes. Favorable outcome depends on prompt institution of appropriate antimicrobial therapy and surgical debridement of involved soft tissues, as well as correction of the underlying disorder. This disease should be considered to be a medical-surgical emergency.

Nontraumatic clostridial myonecrosis

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.

RECOVERY FROM NON-TRAUMATIC LOCALISED GAS GANGRENE AND CLOSTRIDIAL SEPTICÆMIA

Non-traumatic clostridial infections present either as septicæmia or as a metastatic localised lesion. Almost all such infections occur in elderly debilitated patients with ulcerating lesions in the gastrointestinal, biliary, or genitourinary tracts. In addition, most cases have developed in diabetics or in patients receiving cancer chemotherapeutic agents. All eight reported cases of non-traumatic clostridial myonecrosis have died of overwhelming clostridial infection, usually within 24 hours. The case described here was recognised early and treated promptly by debridement of necrotic muscle and by hyperbaric oxygen. This 74-year-old man recovered completely from the gas gangrene, though he died 3 weeks later with widespread gram-negative sepsis.