#IdBoardReview 65 M presents w/ severe pain in leg for few hours, progressed to rapid swelling/bullae and +gas on X-ray. hx of bright blood per rectum for few months. diagnosis? #idmedEd #medEd 
#Clostridium septicum spontaneous non-traumatic gas gangrene associated with malignancy likely colorectal CA in this case
Spontaneous traumatic gas gangrene is most commonly due to Clostridium perfingens & sometimes other clostridia sp. Non-traumatic spontaneous gas gangrene: most commonly due to C septicum: 80% malignancy related, most common CA are colon f/b hematologic
Clostridium septicum 1st isolated from blood of 🐄 in 1877 by L. Pasteur &J. Joubert. 1881 R. Koch: organism responsible for malignant edema (acute, rapidly fatal toxaemia usually caused by Clostridium species). Gram+ spore-forming bacillus in soil
multiple exotoxins: alpha, beta, gamma & delta toxins. alpha toxin is lethal, hemolytic & necrotizing. C. septicum is more aerotolerant than C. perfringens; thus it is more likely to infect healthy tissue
C. septicum has also been transmitted from contaminated musculoskeletal allografts (tendons, menisci, femoral condyles) harvested from cadaveric tissues
abrupt onset of severe muscle pain (Occasional heaviness or numbness) f/b rapid development of edema & bullae filled with clear, cloudy, hemorrhagic, or purplish fluid. Definitive diagnosis: demonstration of large gram-variable rods at the site of injury.
Tx: early surgical debridement & antibiotic therapy. Empiric tx: pip/tazo plus clindamycin. Once pathogen identified: penicillin+clinda. Mortality: 67-100%
