A 50-year-old male presented with swelling and black discoloration of the right leg two days after a road traffic accident. He had multiple open wounds on the right leg that were contaminated. He developed fever, lightheadedness, and worsening leg pain. On examination, the wounds had bronze discoloration and crepitus was felt. Laboratory analysis found Gram-positive bacilli and cultures grew Clostridium perfringens, confirming a diagnosis of gas gangrene. The patient underwent wound debridement and was treated with intravenous metronidazole and gentamicin.

1. Clinical Case presentation
Gas Gangrene
Dr Vishal Kulkarni
MBBS MD (Microbiology)

2.  Case history
 50 years old, male patient came in casualty department with the
history of road traffic accident 2 days ago with c/o-
 Multiple open wounds and swelling on right leg since 2 days.
 Pain and heaviness in right leg since 2 days.
 Fever since 1 day
 Lightheadness since 1 day

3.  H/O present Illness:
 Patient was apparently alright 2 days back when he had road traffic accident
while travelling on his bike to his village. He fell from his bike on ground.
He had no immediate complain except mild pain and multiple open wounds
on right leg. The wounds were contaminated with soil and blood.
 He had local treatment in a primary health centre from which he referred to
our hospital.
 He was having swelling, involving right leg, progressing gradually with
black discoloration since 2 days.

4.  He had pain in right leg which was sudden in onset,
worsening gradually.
 He also had low grade fever which was insidious in
onset, progressed gradually.
 He also had been complaining lightheadness &
disorientation along with drowsiness and fatigue.
 No h/o of any spasms, convulsions
 No H/o TB, DM, HTN, Asthma etc

5. Past History:-
 No h/o similar complains in past.
Family History:-
No significant family history is present.

6.  General Examination:-
 Patient was drowsy, and not oriented with time, place and
person.
 Temp: 99.4 degree F.
 Pulse- 120 / min Regular, all peripheral pulses felt.
 R/R- 22/ min
 BP- 90/70
 No H/O cynosis, clubbing ,lymphadenopathy.

7. Local examination-
Inspection-
 7—8 multiple open wounds on right leg, varying in
size and shape, oozing out serosanguinous discharge,
few were ulcerated with bronze discoloration of
surrounding skin.
 Few wounds involving muscles tissues which were
necrosed
 Oedematous swelling over right leg.

8.  Palpation-
 Warmth ++
 Tenderness ++
 Crepitus +++
 Systemic examination-
 CVS- NAD
 RS- NAD
 CNS- NAD

9.  Differential diagnosis
 Clostridium perfringens
 Clostridium septicum
 Clostridium novyi
 Clostridium tetani
 E. coli
 Proteus
 Staphylococci
 Anaerobic streptococci

10.  Lab.diagnosis:
 Sample Collection-
 Films from muscles at the edge of affected area
 Tissue in necrotic area
 Exudates from part from where infection appears to be most
active.
 Collected with capillary pipette or swab
 Transported to laboratory immediately

11.  Gram stain-
 Scanty pus cells.
 Large number of regularly shaped, Gram positive bacilli
without spores

12.  Emergency Treatment-
 Surgery along with prophylactic antibiotics were advised
 Metronidazole & Gentamicin IV before surgery (8 hrly x
24 hrs)
 All damaged tissues were removed promptly
 Uncompromised excision of all damaged parts was done.

13.  Culture-
 Aerobic culture-
 Mac conkey- 4-5 LFF colonies
 BA- 5-6 large gray moist colonies.

14.  Anaerobic culture
 RCM broth were inoculated
 Media turned pink on incubation
 Incubated and subcultured on BA after 24-48 hrs
 Haemolysis positive on BA with large grey moist colonies.

15.  Naegler reaction-
 Positive

16.  IMViC-
1. (++--)
2. (-+--)
 TSI-
1. A/A without gas
2. A/A with H₂S
 Reverse CAMP test- Positive

17. Diagnosis-
 Based on above findings diagnosis is likely to be a case of Gas
gangrene caused by infection of Clostridium perfringens.

18.  Post-operative treatment-
 Post-op care was taken.
 Metronidazole and gentamicin was continued for another
48 hours.