Kaur M, Dhillon M, Angrup A, Rangasamy K. Polymicrobial infection presenting as non-clostridial gas gangrene in a non-diabetic trauma patient. A case report and review of literature.
INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2022;
12:194-203. [PMID:
36420102 PMCID:
PMC9677224]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND
Clostridium species are known to be the primary causative organism of gas gangrene. Non-clostridial gas gangrene (NCGG) is another rare necrotizing entity often associated with an underlying disease, particularly diabetes mellitus, and has a high mortality rate.
CASE REPORT
A 16-year-old, immunocompetent male was referred to us after four days, following a roadside accident, with a degloving injury over the thigh and knee along with fractures around the knee. Although clinico-radiologically suspicious of gas gangrene, the initial smear report was negative for any Gram-positive bacilli. On the same day, he underwent aggressive debridement with an external fixator spanning the knee to salvage the limb. On post-operative day one, due to deteriorating general clinical condition and a strong clinical suspicion of gas gangrene, he underwent above-knee amputation (open stump) after discussion with microbiologists and physicians.
RESULTS
Polymicrobial non-clostridial infection was seen in culture reports taken serially at different stages of management. The latest follow-up showed a healed amputation stump following split skin grafting.
CONCLUSION
Although rare, polymicrobial infections can present as non-clostridial gas gangrene even in an immunocompetent patient. A high index of clinical suspicion with a multi-disciplinary approach helps in early decision-making to avoid a devastating outcome.
Collapse