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Gas-producing soft tissue infections have been historically attributed to clostridial species; however, organisms in both the Enterobacteriaceae family as well as certain Gram-positive organisms have also been identified as causative organisms. Soft tissue infections are known to progress with an aggressive course, one that often necessitates urgent surgical debridement, amputation, and a prolonged course of antibiotics. If treatment measures are delayed, the clinical course can progress rapidly leading to life-threatening situations. Patients with significant medical comorbidities, such as those with cancer and its associated immunosuppression due to neutropenia and chemotherapy, are at the highest risk for these lifethreatening complications. Here we present a case of a 26-year-old patient with relapsed acute lymphocytic leukemia complicated by neutropenia and a right upper extremity gas-forming infection due to Escherichia coli and discuss the gas-producing soft tissue infections other than Clostridia.

Chilaiditi sign is a rare, usually benign intestinal radiographic phenomenon, produced by the interposition of the colon or small bowel in the hepatodiaphragmatic space. Clinically, it can appear as an asymptomatic anatomic abnormality or with an array of gastrointestinal symptoms, most commonly abdominal pain. Diagnosis is usually an incidental finding noted on routine chest x-ray. Identification of Chilaiditi sign is important to recognize to limit unnecessary radiologic and surgical interventions. We present the case of a 71-year-old man with an incidental chest x-ray finding of gaseous distention below the right hemidiaphragm. He was asymptomatic and managed conservatively.

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