Abstract
We report a case of 23-year-old female with acute lymphoblastic leukemia (ALL) terminating in gas producing cellulitis presumably due to gram-negative bacterial infection. She was diagnosed as having ALL (null cell type, TdT positive) on April 24, 1980, at Jichi Medical School Hospital and achieved complete remission (CR) with the administration of five courses of VP therapy consisting of vincristine and prednisolone. On March 11, 1981, she was admitted to the hospital for the third time because of relapse. Despite of several courses of various combination chemotherapy, she failed to achieve CR. When her granulocyte count became almost zero in August, she complained of high-grade fever and a pain in the perianal region. She was found to have a rapidly progressive perianal cellulitis. On August 27, 1981, subcutaneous emphysema developed in bilateral forearms and inguinal regions, and septicemia due to gas producing microorganisms was suggested. In spite of an intensive combination therapy of antibiotics, her condition rapidly deteriorated, and she expired on that day.
At autopsy bone marrow was marked hypocellularity with scattered foci of leukemic cells. It was to be noted that subcutaneous and mediastinal emphysema, and generalized bacterial embolism, prominent in the liver, kidneys, lungs, and rectum were detected. Postmortal bacterial culture revealed Klebsiella pneumoniae, although the anaerobic culture technique carelessly was not performed. These findings may suggest a possibility that in this case K. pneumoniae produced gas in many organs.
Although gas producing infection is a relatively rare complication of leukemia, we should always keep in mind the gas producing cellulitis and abscess.
