Thompson Kristine M, Kruse Brian T, Hedges Mary Ann S
Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida.
Division of Community Internal Medicine, Mayo Clinic, Jacksonville, Florida.
J Emerg Med. 2018 Jun;54(6):e121-e123. doi: 10.1016/j.jemermed.2018.01.036. Epub 2018 Mar 10.
Necrotizing fasciitis is usually associated with a surgical or traumatic wound. Clostridial myonecrosis is an uncommon but deadly infection that can develop in the absence of a wound and is often associated with occult gastrointestinal cancer or immunocompromise, or both.
We report a case of catastrophic atraumatic Clostridium septicum infection in an immunocompromised host. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians most commonly associate necrotizing fasciitis with superinfection of an open wound. This case reminds physicians that patients with acquired neutropenia can present with spontaneous gas gangrene due to C. septicum. Providers should consider this diagnosis in immunocompromised patients who present with acute onset of severe atraumatic limb pain.
坏死性筋膜炎通常与手术或创伤性伤口相关。梭菌性肌坏死是一种罕见但致命的感染，可在无伤口的情况下发生，且常与隐匿性胃肠道癌或免疫功能低下，或两者都有关。
我们报告一例免疫功能低下宿主发生的灾难性非创伤性败血梭菌感染病例。
急诊医生为何应知晓此事？：急诊医生通常将坏死性筋膜炎与开放性伤口的二重感染联系在一起。本病例提醒医生，获得性中性粒细胞减少症患者可能因败血梭菌而出现自发性气性坏疽。对于出现急性发作的严重非创伤性肢体疼痛的免疫功能低下患者，医疗人员应考虑这一诊断。
