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Spontaneous Clostridium perfringens myonecrosis of the shoulder: a case report
Brent Lanting1, George S Athwal, Douglas D R Naudie
1Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada.
Abstract:
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.
Insights
A rare Clostridium perfringens infection developed atypically in a healthy patient after head trauma. This case highlights a slow progression of clostridial myonecrosis, offering unique insights into the disease.
Area of Science:
- Infectious Diseases
- Musculoskeletal Infections
- Medical Case Studies
Background:
- Clostridium perfringens causes rare, life-threatening infections.
- Spontaneous myonecrosis is a severe manifestation of C. perfringens infection.
Observation:
- A healthy patient developed fever and positive blood cultures for C. perfringens following a head injury.
- Subcutaneous emphysema and necrotic supraspinatus muscle were identified 72 hours after initial culture results.
- The patient's condition progressed with a delayed onset of clinical myonecrosis.
Findings:
- This case presents an atypical, slower-than-usual progression of C. perfringens myonecrosis.
- Multiple surgical débridements were necessary to manage the extensive muscle necrosis.
- The study offers a unique opportunity to observe clostridial myonecrosis in a monitored, healthy individual.
Implications:
- Understanding atypical presentations of C. perfringens infections is crucial for timely diagnosis and treatment.
- This case challenges the classic understanding of rapid progression in clostridial myonecrosis.
- Further research into the factors influencing the pace of C. perfringens myonecrosis progression is warranted.
