中性粒细胞减少患者中的梭状芽胞杆菌气候坏疽

气候坏死是由灌注梭状芽胞杆菌，切丁氏梭菌和其他梭状芽胞杆菌引起的坏死筋膜炎的罕见表现。随着它的快速发展，它是一种潜在的威胁生命的感染，这在需要跨学科方法的临床管理中构成了挑战。在这里，我们提出了一名62岁的女性，在对三重阴性乳腺癌进行化学疗法的同时，她们患有中性粒细胞膜发烧。她发表了高烧，报告左大腿几乎没有疼痛，伴随着当地的发红和硬度。随后，患者出现了左手背面的疼痛和发红。最初的发现表明蜂窝织术和静脉注射美培植物的立即经验治疗开始了。尽管进行了抗生素治疗，但患者随着局部感染的发展迅速发展了败血性休克。紧急手术清创术显示软组织的广泛坏死，包括大腿的广泛肌瘤。左手进行了广泛的清创术，无法保留左下肢，并且需要左臀部的伸展。在不同样品中分离了微生物学的食s，确认气体坏疽。由于皮肤上没有局部进入门户，因此怀疑该中性粒细胞减少患者的肠道易位播种。经验性抗生素治疗量身定制为静脉注册青霉素，并与克林霉素补充毒素抑制作用。从根治性的清创术和抗生素治疗后，可以稳定患者。重复的清创术闭合后，将患者出院以康复。抗生素治疗持续了四个星期。中性粒细胞减少患者中的罕见气体坏疽病例表明，免疫功能低下患者中坏死性软组织感染的诊断和治疗管理的复杂性。它尤其突出了跨学科管理的重要性，并快速识别该疾病，并在需要的情况下快速（如果需要）进行激进的手术清创术以及量身定制的抗生素治疗以取得成功。

Gas gangrene is a rare presentation of a necrotizing fasciitis, caused by Clostridium perfringens, C. septicum and other clostridial species. With its rapid progression it is a potentially life-threatening infection, that poses as a challenge in the clinical management requiring an interdisciplinary approach.Here we present a 62-year-old woman, who developed neutropenic fever while undergoing chemotherapy for triple negative breast cancer. She presented with a high fever, reporting little pain in her left thigh accompanied by redness and induration locally. Subsequently the patient developed pain and redness of the back of the left hand. The initial findings suggested cellulitis and immediate empiric treatment with intravenous meropenem was started. Despite the antibiotic treatment the patient rapidly developed septic shock along with progression of the local infection. Emergency surgical debridement revealed extensive necrosis of the soft tissues including extensive myonecrosis of the thigh. On the left hand an extensive debridement was performed, the left lower limb could not be preserved and exarticulation of the left hip was required. Microbiologically C. septicum was isolated in different samples, confirming gas gangrene. As there was no local entry portal on the skin, hematogenous seeding from intestinal translocation in this neutropenic patient was suspected. The empiric antibiotic treatment was tailored to intravenous penicillin and complemented with clindamycin for toxin inhibition. Following radical debridement and antibiotic treatment, the patient could be stabilized. After repetitive debridement wound closure was achieved and the patient was discharged for rehabilitation. Antibiotic treatment was continued for four weeks.This rare case of gas gangrene in a neutropenic patient shows the complexity in the diagnostic and therapeutic management of necrotizing soft tissue infections in immunocompromised patients. It particularly highlights the importance of an interdisciplinary management with fast recognition of the disease and rapid, if needed radical, surgical debridement as well as tailored antibiotic treatment for a successful outcome.