Genital nonclostridial gas gangrene in a patient on hemodialysis

Abstract

The patient was a 68-year-old woman undergoing hemodialysis due to chronic glomerulonephritis since 1988. She received steroidal medication for myelodysplastic syndrome(MDS)from May 2005, and developed secondary diabetes mellitus(DM). A mass with 1.5 cm in diameter appeared at the genital region on September 17, 2005, and antimicrobial medication was administered. Three days later, subcutaneous emphysema was palpable in the genital region and she was immediately transferred to our hospital. Abdominal X-ray and CT scan demonstrated subcutaneous gases in the genital region, left inguinal and femoral regions. We diagnosed this case as nonclostridial gas gangrene, and extensive incision and debridement were carried out. Bacteroides was identified by culture of the pus. Postoperatively, antimicrobial treatment, irrigation of the skin defect region, and hyperbaric oxygenation exposure of the whole body were performed. After granulation, skin closure was carried out on January 11, 2006. Although our case is rare, we should recognize that DM and steroidal medication can make an infection more severe in hemodialysis patients.