Fulminant Clostridium Septicum myonecrosis in well controlled diabetes: a case report

Abstract

Diabetic myonecrosis with Clostridium Septicum is uncommon but carries a high mortality rate. This commensal organism is part of the gastrointestinal tract flora and can become extremely virulent, often in the setting of immuno-suppression such as neutropenia, occult malignancy (commonly caecal) and poorly controlled diabetes. The case report is unusual in that there are few risk factors other than very mild neutropenia. This highlights the opportunistic character of the organism and recommends that a high index of suspicion and vigilance be carried out in the presence of fevers and sepsis, even in the well-controlled diabetic population.

Figure 1

Plain XR showing extensive and ominous gaseous formation in the left pelvis and thigh.

Figure 2

CT scan of the pelvis confirming the extensive gaseous formation tracking along the fascial planes characteristic of myonecrosis (black arrows). The formed gas also extends into the acetabular gap, giving the crescentic appearance (red arrow). Note the marked adiposity in the form of anterior fat-apron with a ventral wall hernia (large arrow).

Figure 3

Post mortem incision of the necrotic tissue exudes an abundance of gaseous bubbles (arrows).