Images in Clinical Medicine
Gas Gangrene Associated with Occult Cancer
N Engl J Med 2000; 343:1615November 30, 2000
- Article
Figure 1 A 78-year-old man with cardiac disease presented with pain in his left elbow of several hours' duration in the absence of trauma. Examination of the elbow disclosed no abnormalities, and he was admitted with a tentative diagnosis of atypical angina. His white-cell count was 4400 per cubic millimeter. Several hours later, ecchymoses and blistering of the left arm developed (Panel A), with severe pain and soft-tissue crepitus near the elbow. The patient rapidly became unresponsive and severely hypotensive and was immediately transported to the operating room while receiving intravenous penicillin. Radiographs in the operating room revealed subcutaneous gas up to the shoulder (Panel B). Forequarter amputation with primary closure was carried out. Gram's staining of the bullae showed a paucity of white cells and numerous gram-positive rods (arrows, Panel C, ×400), which were later identified as Clostridium septicum. After the patient recovered, additional examinations were performed because of the common occurrence of cancer in association with atraumatic C. septicum infection. Multiple polyps of the sigmoid colon were found, and myelomonocytic leukemia was diagnosed. Multiple dysplastic adenomatous lesions were identified during colonic resection. One year after admission to the hospital, the patient was well except for mild pancytopenia. He declined chemotherapy and returned to work in a local hardware store.
David J. Schneider, M.D.
J. Spence Reid, M.D.
Pennsylvania State University, Hershey, PA 17033- Citing Articles (1)
Citing Articles
1
Saam Morshed, Farbod Malek, Robert M. Silverstein, Richard J. O'Donnell. (2007) Clostridium cadaveris Septic Arthritis after Total Hip Arthroplasty in a Metastatic Breast Cancer Patient. The Journal of Arthroplasty 22:2, 289-292
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