Spontaneous fulminant gas gangrene

Abstract

was a small caecal carcinoma with a 4 cm metastatic deposit in the right lobe of the liver. DISCUSSION Gas gangrene is a condition of rapidly developing and spreading infection mediated by toxins released by the bacteria Clostridium spp. It is most often associated with traumatic injuries. C. perfringens is the commonest species, followed by C. novyi. C. septicum is relatively uncommon, and it is estimated to be the cause of only 1.3% of all clostridial infections. 1-3 C. septicum represents a novel subtype among clostridial species, with several notable differences. It is able to cause devastating tissue necrosis in the absence of prior trauma, 1 3-6 and is able to present distant from the presumed portal of entry resulting in metastatic myonecrosis. 4 5 Clostridial infections are believed to have a greater prevalence among individuals who have malignant disease. 1 4-6 Larson et al, in a series of 241 patients with clostridial infection, found 10% had an associated malignancy. 5 However, when C. septicum infections were considered alone the incidence of associated malignancy was 52.6%. 6 In a further study of patients with C. septicum infection, conducted between 1966 and 1993, 50% had a primary malignancy, 75% of which were colonic, of these 40% were caecal. 5 Few patients presenting with C. septicum infection have a history of prior trauma. 1 4-6 Several papers have suggested that mucosal ulceration of the tumour surface and haematogenous invasion allow a portal of entry for the bacteria, thus explaining the low incidence of antecedent trauma. 7-9 The theory of mucosal ulceration as the portal of entry is supported by the case reported by Abella et al in which a patient with radiation colitis had spontaneous C. septicum gas gangrene. 1 Our case illustrates the fulminant nature of gas gangrene and although it is an uncommon diagnosis, it is essential that the management be initiated early. This should include aggressive resuscitation, early antibiotics, hyperbaric oxygen therapy (although this has never been subjected to a controlled trial and unless it is readily available it would seem to present a potentially fatal delay), and radical surgical debridement.

Pathology of fatal traumatic and nontraumatic clostridial gas gangrene: a histopathological, immunohistochemical, and ultrastructural study of six autopsy cases

“…Left untreated, the disease is almost always fatal, with death often occurring within hours after the onset of the first symptoms [1,5,8,14,22]. In the present series, the time span between onset of the disease and death ranged between 4 and 20 h in four cases and was unknown in the remaining two cases.…”

“…This type of gas gangrene has a strong association with severe underlying diseases and colorectal or hematological malignancies [1,7,10,13,18]. In addition, nontraumatic gas gangrene has also been described to occur in association with a variety of more or less debilitating disorders such as pancreatitis, cholezystitis, perforated duodenal ulcer, liver cirrhosis, diabetes mellitus, and alcohol abuse [1,8,11,14,18,24]. Here, nontraumatic gas gangrene originated from acute pancreatitis in two cases, and the disease was associated with von Willebrand's disease, diabetes mellitus, and chronic alcoholism in one case each.…”

Fatal <i>Clostridium septicum</i> Infection in a Patient with Non-Hodgkin’s Lymphoma Undergoing Multimodal Oncologic Therapy

“…They usually thrive in an anaerobic environment, such as the large intestine [5,6]. Whereas C. perfringens accounts for 90% of cases that are associated with an open wound, nontraumatic gas gangrene is almost exclusively caused by C. septicum [7]. C. septicum is aerotolerant, mobile and capable of infecting non-devitalized tissue.…”

“…Often initial examination of the skin and muscle is unimpressive. Skin edema only occurs later and gas inclusion is the last manifestation -usually already associated with septic shock symptoms [7]. Death usually comes within 12-24 h. Intravenous antibiotics, high-dose penicillin or clindamycin, are the mainstay of treatment [12].…”

A Fulminant Enterocolitis

“…C. septicum is known to be one of the agents Fig. 1 Abdominal computed tomography scan showing pneumoperitoneum and the presence of gas in the colonic wall and portal vein of gangrenes [1,2] and myonecrosis in immunosuppressed patients [3]. A strong correlation between C. septicum bacteremia and digestive cancers is classical.…”