Images in Clinical Medicine

Nontraumatic Clostridium septicum Myonecrosis

Rafael Arteta-Bulos, M.D., and Syed Mustafa Karim, M.D.

N Engl J Med 2004; 351:e15October 21, 2004

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A 73-year-old man with a history of colon cancer presented to the emergency department with a three-day history of pain in the right hip, without a history of trauma. He was admitted to the coronary care unit for management of a third-degree atrioventricular block. He was febrile, with leukocytosis; blood cultures were ordered, and antibiotic therapy was begun. Seven hours after admission, swelling of the right leg was noticed, along with blisters and soft-tissue crepitus. A computed tomographic scan showed gas and extensive myonecrosis in the right leg (Panel A) and pelvis (Panel B). According to the patient's advance directive, emergency amputation was not pursued. The patient died three hours later. The blood cultures later grew Clostridium septicum.

Rafael Arteta-Bulos, M.D.
Syed Mustafa Karim, M.D.
Henry Ford Hospital, Detroit, MI 48202

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