Abstract
A 49-year-old man was referred to the hospital because of a swelling and pain of the left femur. He had a fever from 12 days before and claudiacation from 9 days before. In addition, he had respiratory disturbance on his first visit. From his clinical course and local findings, gaseous gangrene was suspected. Plain reontgenography and CT revealed gasses in the subcutaneous tissue and muscularis. The necrotic fascia of the left femur was resected and the wound was left open. Postoperatively, septic shock and respiratory failure appeared. At 12 hours after the operation new pus and necrosis of the fascia appeared. Lower leg was amputated and his life was saved. From cultures of pus obtained from the wound, E. faecalis was isolated and identified. Then, E. faecalise was replaced by Pseudomonas aeruginosa, MRSA and fungi. When an inflammatory lesion of the soft tissue is progressive and associated with systemic symptoms, roentgenographic examinations under a suspicion of possible gaseous gangrane is essantial, followed by marking the differentiation between infections due to clostridium and non-clostridium for better decision of treatment policy. This case is thought very interesting in that the patient had not history of trauma or any underlying diseases such as diabetes mellitus.
