Spontaneous Clostridium perfringens myonecrosis of the shoulder: a case report

• Published in: Clinical orthopaedics and related research Vol. 461; p. 20
• Main Authors: Lanting, Brent, Athwal, George S, Naudie, Douglas D R
• Format: Journal Article
• Language: English
• Published: United States 01-08-2007
• Subjects: Adult; Clostridium perfringens; Debridement; Disease Progression; Gas Gangrene - surgery; Gas Gangrene - therapy; Humans; Magnetic Resonance Imaging; Male; Muscle, Skeletal - microbiology; Muscle, Skeletal - pathology; Necrosis; Radiography; Shoulder - diagnostic imaging; Shoulder - microbiology; Shoulder - pathology; Subcutaneous Emphysema - diagnostic imaging; Subcutaneous Emphysema - microbiology
• ISSN: 0009-921X
• DOI: 10.1097/BLO.0b013e318073c273

Clostridium perfringens is a rare, life-threatening infection. We present an atypical evolution of spontaneous Clostridium perfringens myonecrosis in a monitored healthy patient. After a head injury, the hemodynamically stable patient became febrile and grew cultures of Clostridium perfringens with no identifiable focus. Antibiotics were initiated. Seventy-two hours after culture results, the patient complained of shoulder pain and imaging revealed periscapular subcutaneous emphysema. Multiple surgical débridements of the necrotic supraspinatus muscle were required to eradicate the infection. The unique features of this patient include the opportunity to (1) follow the progression of clostridial myonecrosis in a healthy patient in a monitored setting and (2) study the extended period of time between positive cultures and the onset of clinical myonecrosis, a feature at odds with the classic rapid progression.