Four cases of non-clostridial gas gangrene with diabetes mellitus

Abstract

We report four cases of non-clostridial gas gangrene. All cases were associated with diabetes mellitus as the underlying disease. Case 1: a 60-year-old male developed an ulcerative lesion on the dorsum of his left foot. Peptostreptococcus asaccharolyticus, Citrobacter freundii and Staphyrococcus epidermidis were identified in culture from odoriferous pus. Case 2: a 81-year-old female developed a lesion on her vulva spreading to the right lower abdomen. Bacteroides bivius, Peptostreptococcus asaccharolyticus and Streptococcus faecalis were identified in culture of the odoriferous pus. Case 3: a 80-year-old male developed a swollen area with ulcer on the right foot. Bacteroides fragiris, Enterococcus faecalis, Proteus mirabilis, Enterococcus avium and Enterococcus faecalis were identified by culture. Case 4: a 52-year-old female developed swelling of her left groin. Enterococcus faecalis and Streptococcus anginosus were identified in culture from the odoriferous pus. In all patients, a radiological examination revealed the presence of subcutaneous gas in the lesion. Prognosis of non-clostridial gas gangrene is usually poor. These four patients, however, all survived. Once an infectious sign is seen in the diabetic patient, it is important to discover a gas figure by using the radiological examination (plain film or computed tomography). Earlier diagnosis and debridement are the most important for a better prognosis. Because workers with diabetes mellitus are now increasing in number, occupational physicians should always keep in mind that a serious infectious disease like non-clostridial gas gangrene can develop even from minor accidental trauma, and they should control the working environment in the workplace where accidents often happen.