A survived case of diabetes with nonclostridial gas gangrene

A 56-year old diabetic patient of over 20 years duration was admitted with gangrene of right foot. About a month prior to admission he injured the fourth toe of the right leg when he cut the toe nail. Two weeks later necrotic ulcer was present on it with cellulitis and 2nd, 3rd and 5th toes were also affected. Then his entire right leg was swollen and he developed fever. In spite of the treatment with antibiotics and insulin, gangrenous lesions progressed and subcutaneous emphysema was palpable beneath the inflamed area. On the 9th hospital day amputation was carried out below the knee. He had a good recovery 6 weeks after the amputation. Aerobic and anerobic cultures from the foot yielded bacteroides and pseudomonas aeruginosa. Clostridia were not isolated. A review was also carried out on ten diabetic cases of nonclostridial gas gangrene in the lower limb in Japan.