A 42 year-old male, who was a known case of borderline lepromatous leprosy on treatment with WHO MB-MDT, presented to us in a state of stupor. One week previously, while on a pilgrimage, he walked bare foot for a long distance, following which he noticed pain and swelling in his left leg. On examination, the patient was disorientated, tachypnoeic, febrile and had tachycardia with hypotension (systolic BP 90 mm Hg and diastolic 60 mm Hg). Examination of the left leg revealed a trophic ulcer on the sole and diffuse swelling with vesiculo–bullous lesions extending up to the knee. There was a foul-smelling serosanguinous discharge with crepitus on palpation of the swollen leg. Gram stain of the bulla fluid showed pleomorphic, gram-positive bacilli and a few leukocytes. Investigations on admission revealed a white blood cell count of 16 000 cells/mm with 78% neutrophils, 20% lymphocytes and 2% monocytes. Blood urea, creatinine, urine examination and serum electrolytes were within normal limits. Blood glucose was 110 mg/dl. X-ray of the left leg revealed diffuse gas bubbles in the intramuscular tissue planes extending from the foot to the thigh (Figures 1 and 2). Treatment with intravenous antibiotics (benzyl penicillin, metronidazole and gentamicin) was started immediately. Hip disarticulation was performed due to the rapid spread of infection. However he deteriorated rapidly and died due to multi-organ failure, 72 hours after the onset of symptoms. Gas gangrene is caused by exotoxin-producing Clostridial species (large, gram-positive, spore-forming bacilli). Clostridium perfringens causes 80–95% of cases of gas gangrene. The incubation period between injury and onset of symptoms is approximately 1–3 days, but can be as short as hours. Typically, the onset is sudden. There is severe pain out of proportion to the external evidence of infection. Cutaneous manifestations consist of tense, oedematous, pale skin that progresses to tense bullae filled with serosanguinous fluid, followed by violaceous dermal necrosis. There is an associated brownish, foul-smelling discharge,