Characteristic manifestations of clostridium induced spontaneous gangrenous myositis

Spontaneous clostridial myonecrosis occurred in 30- and 69-year-old patients with pancytopenia (after treatment of acute myelogenous leukemia) and diabetes with neutropenia respectively. They presented with fever and sudden onset of pain plus tenderness in involved muscles. They rapidly deteriorated and died within hours after admission. A review of the literature for previous reports of this condition disclosed 31 additional cases. Mean age of patients was 50 years, male to female ratio was 2.2:1, and an underlying condition was present in all of them. Presenting manifestations were spontaneously occurring excruciating pain in the involved muscle (67%), generalized sepsis and shock (24%), nonpainful swelling in the involved muscles (6%) and pain, swelling and shock (3%). Mortality rate was 91% (30/33). The clostridial strains associated with this condition were identified in 31 cases, with Clostridium perfringens and C. septicum causing 28 of them. Bacteremia was described in 10 cases. Awareness of this rare catastrophe may aid in early recognition and surgical intervention which are essential for patient survival.