Leung F W, Serota A I, Mulligan M E, George W L, Finegold S M
Ann Emerg Med. 1981 Jun;10(6):312-4. doi: 10.1016/s0196-0644(81)80122-9.
A 64-year-old man presented with a history of four days of lower abdominal pain and 12 hours of cutaneous discoloration, bullae formation, and swelling of the soft tissues of abdominal wall and right thigh. Myonecrosis of abdominal wall and an adenocarcinoma of the cecum were found at operation. Cultures of blood and fluid from the bullae yielded Clostridium septicum. Nontraumatic clostridial myonecrosis is a fulminant, usually fatal disease that is most often the result of bacteremia from an occult gastrointestinal lesion. Ulceration of the colon or terminal ileum is the most common predisposing condition, and is usually due to gastrointestinal or hematological malignancy. Patients often present with nonspecific complaints, including pain at the affected site and fever. The disease progresses rapidly to include bronze discoloration, edema, and hemorrhagic bullous lesions of the skin, subcutaneous emphysema, and myonecrosis. Presumptive diagnosis often can be made by Gram stain of the bullous fluid that reveals gram-positive bacilli and a paucity of leukocytes. Favorable outcome depends on prompt institution of appropriate antimicrobial therapy and surgical debridement of involved soft tissues, as well as correction of the underlying disorder. This disease should be considered to be a medical-surgical emergency.
一名64岁男性，有4天的下腹部疼痛病史，以及12小时的皮肤变色、大疱形成和腹壁及右大腿软组织肿胀。手术中发现腹壁肌坏死和盲肠腺癌。血液和大疱内液体培养出败血梭状芽孢杆菌。非创伤性梭状芽孢杆菌性肌坏死是一种暴发性疾病，通常是致命的，最常见的原因是隐匿性胃肠道病变引起的菌血症。结肠或回肠末端溃疡是最常见的诱发因素，通常由胃肠道或血液系统恶性肿瘤引起。患者常表现为非特异性症状，包括受累部位疼痛和发热。疾病迅速进展，出现皮肤青铜色变色、水肿、出血性大疱病变、皮下气肿和肌坏死。通过对大疱内液体进行革兰氏染色显示革兰氏阳性杆菌且白细胞数量稀少，常可作出初步诊断。良好的预后取决于及时开始适当的抗菌治疗、对受累软组织进行手术清创以及纠正潜在疾病。本病应被视为内科-外科急症。
