Clostridium Septicum: Cause of Gas Gangrene in the Upper Extremity Leading to Proximal Trans-Humeral Amputation, A Review of Clostridium septicum

Abstract

Introduction: Gas gangrene is a rare, often lethal infection of soft tissue that is commonly associated with the Clostridial species due to penetrating injuries. Case reports of spontaneous atraumatic gas gangrene due to the Clostridium septicum species are exceedingly rare. Atraumatic C. septicum is notably related to bowel pathologies, immunodeficiencies, and individuals with vascular insufficiency. The rapid progression of Clostridium myonecrosis contributes to its high mortality rates.

Case report: The authors report a case of a 71-year-old right-hand-dominant female who developed fulminant atraumatic left forearm pain and swelling. The patient was indicated for emergent irrigation and debridement (I&D) of the left upper extremity. She was later found to have C. septicum bacteremia and required multiple I&Ds including the left side of the neck and chest wall. Repeat post-operative examinations revealed no motor function or sensation distal to the elbow and she was subsequently indicated for a proximal trans-humeral amputation.

Conclusion: Although she had a prolonged hospital stay, she progressed well and was eventually discharged to a rehabilitation facility. This case report highlights the importance of early recognition of Clostridial myonecrosis as well as the need for emergent surgical intervention for the patient's survival.

Keywords: Clostridium septicum infection; Trans-humeral amputation; gas gangrene.

Figure 1

(a) Clinical photograph of volar wrist with signs of hyperpigmentation upon initial evaluation in the emergency department (ED). (b) Clinical photograph of the dorsal arm upon initial evaluation in the ED.

Figure 2

(a) Clinical photograph of dorsal arm and forearm demonstrating significant bullae formation and discoloration upon orthopedic evaluation. (b) Clinical photograph of volar arm and forearm demonstrating significant bullae formation and discoloration upon orthopedic evaluation.

Figure 3

(a) Anteroposterior X-ray of the left forearm demonstrating subcutaneous air in the radial aspect of the forearm. (b) Lateral radiograph of the left forearm demonstrating subcutaneous air through the volar forearm. (c) Lateral X-ray of the wrist demonstrating subcutaneous air in the volar aspect of the wrist and distal forearm. (d) Posteroanterior radiograph of the wrist demonstrating subcutaneous air in the radial aspect of the wrist and distal forearm.

Figure 4

Clinical photograph demonstrating the first irrigation and debridement and fasiciotomy of the left upper extremity.

Figure 5

(a) Post-operative anteroposterior radiograph of the Left shoulder after transhumeral amputation. (b) Clinical radiograph status post-transhumeral amputation of the left upper extremity.