¹Chen D, ¹LaGreca M, ¹Frick P, ¹Egger A, ¹Bennett N, ²Mayberry J
¹Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA; ²Lankenau Medical Center, Wynnewood, PA, USA

Gas gangrene is a rare, often lethal infection of soft tissue that is commonly associated with the Clostridial species due to penetrating injuries. There have been some previous reports of spontaneous atraumatic gas gangrene due to the C. septicum species. Atraumatic C. septicum is notably related to bowel pathologies, immunodeficiencies, and individuals with vascular insufficiency. The rapid progression of Clostridium myonecrosis contributes to its high mortality rates.

The authors report a case of a 71 year old female, right hand dominant, who developed rapidly progressive atraumatic left forearm pain and swelling. On examination she had subcutaneous emphysema along the length of the forearm with significant pain out of proportion to exam. She was indicated for emergent irrigation and debridement (I&D) of the left upper extremity. She was later found to have C. septicum bacteremia and required multiple I&Ds including the left side of the neck and chest wall. Repeat postoperative examinations revealed no motor or sensation distal to the elbow and she was subsequently indicated for a proximal trans-humeral amputation. Though she had a prolonged hospital stay, she progressed well and was eventually discharged to a rehabilitation facility. This case report highlights the importance of early recognition of Clostridial myonecrosis as well as the need for emergent surgical intervention for the patient’s survival.