Iatrogenic non-clostridial gas gangrene in a diabetic patient – A case report

Abstract text (incl. references and figure legends)

CASE HISTORY: A 77-year-old male, with type 2 diabetes, presented to the ER with acute pain in his left arm. Patient had no history of trauma, except from an intramuscular injection into his left deltoid muscle for COVID-19 vaccination 60 days ago.

CLINICAL FINDINGS: Upon arrival, no clinical findings were identified. The differential diagnosis involved coronary disease and trauma. During his examination, the skin of the left arm showed rapidly increasing inflammation signs.

RESULTS: X-ray and CT of the affected arm were suggestive of subcutaneous gas shadows. Blood tests resulted in a LRINEC score "8".

DIAGNOSIS: The initial diagnosis set was gas gangrene of the arm possibly due to the intramuscular injection.

THERAPY AND PROGRESSIONS: Patient was resuscitated with IV fluids and antibiotics. Multiple operations for excessive debridement of the necrotic soft tissue were performed. No bacteria were isolated from the tissue removed. Patient succumbed to multiple organ failure in the ICU one month later.

COMMENTS: Gas gangrene is a rapidly progressive necrotic infection of the soft tissue associated with high mortality. Non-clostridial gas gangrene is relatively rare. The patient may show symptoms days after the initiative event. Thus, high clinical suspicion is necessary for prompt diagnosis.

REFERENCES

Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections*: Critical Care Medicine. 2004 Jul;32(7):1535–41. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2014 Jul 15;59(2):e10–52.

FIGURE 1: X-ray of the left arm

FIGURE 2: Surgical debridement of the left arm

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