Clostridium myonecrosis - a rare and underdiagnosed condition in the elderly: a case with severe skipping lesions and an overview of treatment guidelines

Abstract

We present an unusual and severe case of spontaneous clostridial myonecrosis (SCM) in an elderly patient, with severe skipping lesions spread throughout the body. CT imaging, combined with postmortem available blood cultures, confirmed the diagnosis. We noted an underrepresentation of SCM in the cohort of elderly patients (≥ 85 years), upon a review of case reports in the literature over the last decade. Given the worldwide demographic change resulting in an increase in the number of visits to emergency departments for this age group, it is likely that SCM is underdiagnosed in these elderly patients. This case report aims to increase awareness among emergency physicians to recognize the disease as well as to provide a treatment guideline, in order to provide better care and outcome.

Keywords: Clostridial myonecrosis; Clostridium septicum; Gas gangrene; Spontaneous clostridial myonecrosis.

Fig. 1

Purple discoloration and bullae formation of the left leg

Fig. 2

Detailed view of lower left leg

Fig. 3

A suspicious big polypus mass in the colon at the valve of Bauhin, possibly ct2N0M0

Fig. 4

Gas surrounding the iliac vessels on the right side

Fig. 5

Gas in the retroperitoneal space most profound at the intervertebral space of L5-S1 with spreading along the iliac veins, most remarkable on the right side. Suspicion of localized osteonecrosis in L5-S1

Fig. 6

Gas bubble in the popliteal artery on the right side

Fig. 7

Gas in the right lower leg muscle compartment

Fig. 8

Gas in both leg muscle compartments