Elsevier

The Journal of Foot and Ankle Surgery

Volume 49, Issue 2, March–April 2010, Pages 159.e1-159.e8
The Journal of Foot and Ankle Surgery

Case Report
Clostridium septicum Necrotizing Fasciitis of the Forefoot Secondary to Adenocarcinoma of the Colon: Case Report and Review of the Literature

https://doi.org/10.1053/j.jfas.2009.06.007Get rights and content

Abstract

Clostridium septicum accounts for 1% of all reported clostridial infections. C septicum infections are most often nontraumatic in nature and associated with either an occult colonic or hematologic malignancy. The initial presentation of a C septicum infection can be relatively benign with rapid progression to fatality without emergent treatment. Presented is a case of necrotizing fasciitis of the forefoot caused by C septicum associated with an occult adenocarcinoma of the colon in a patient with uncontrolled diabetes. The process we used to achieve successful functional limb preservation based on rapid surgical intervention and use of a multidisciplinary approach to medical and surgical management of this patient is discussed in detail, as well as a through review of the literature regarding the association between malignancies and C septicum infections.

Section snippets

Case Presentation

A 61-year-old Asian female presented to the Emergency Department with a chief complaint of approximately 10 hours of pain localized to her right lateral forefoot. The patient stated that the pain awoke her in the morning and persisted throughout the day. She then noticed fixed discoloration of the fourth and fifth digits on her right foot, which prompted her to present to the Emergency Department. The Vascular Surgery Service was initially consulted because of concern for an acute thrombolic

Discussion

Kornbluth et al (4) performed the first study regarding all nontraumatic C septicum infections reported between 1945 and 1987. A total of 162 cases were found. Of those cases, 131 (81%) were found to have an associated malignancy. Fifty-five patients (34%) were found to have a gastrointestinal malignancy, with 26 of these cases (47%) being a cecal malignancy and the remaining 29 cases (53%) being all other types of colorectal carcinoma. Sixty-five cases (40%) had a hematologic malignancy. The

References (29)

  • H. Tehrani et al.

    Fatal multifocal metastasis of Clostridium septicum: a case report

    Brit Assoc Plast Surg

    (2004)
  • A.J. Emmett

    The filleted toe flap

    Br J Plast Surg

    (1976)
  • M.S. Delbridge et al.

    Spontaneous fulminant gas gangrene

    Emerg Med J

    (2005)
  • A.A. Kornbluth et al.

    Clostridium septicum infection and associated malignancy. Report of 2 cases and review of the literature

    Medicine (Baltimore)

    (1989)
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    Disclaimer: The opinions or assertions contained herein are the private view of the author and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.

    Financial Disclosure: None reported.

    Conflict of Interest: None reported.

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