What's the Diagnosis? By Dr. Lauren Murphy
Wed, 12/13/2017 - 7:00am
A 26 yo M presents to the ED with a chief complaint of R foot pain for 1 month. He has been using an ACE wrap over a wound, but has not changed the bandage in 2 weeks. He reports foul smelling drainage seeping through the bandage. An xray is obtained. What's the diagnosis? (scroll down for answer)
Answer: Gas gangrene and osteonecrosis of the 5th metatarsal/phalanx (also note healing fractures with callus formation)
- highly lethal necrotizing soft tissue infection of skeletal muscle caused by toxin and gas-producing Clostridium species
- most cases are traumatic and result from penetrating injury and inoculation of muscle tissue with Clostridium perfringens, an anaerobic bacteria found in sewage and soil
- patients typically present with severe pain at site of injury, followed by skin changes overlying the affected area (pallor--> red/purple discoloration--> blister/bullae formation-->crepitus)
- disease progression is rapid and systemic toxicity and multiorgan failure may occur within hours of presentation
- MRI is more sensitive than xray for diagnosis of gangrene/osteonecrosis, but imaging should not delay treatment
- requires emergent surgical consult, initiation of fluid resuscitation and broad spectrum antibiotic therapy
- definitive diagnosis is made by surgical exploration and demonstration of the organism in tissue