气性坏疽是一种罕见的坏死性筋膜炎，由产气荚膜梭菌、败血梭菌和其他梭菌引起。由于其进展迅速，它是一种潜在危及生命的感染，这给临床管理带来了挑战，需要采取跨学科的方法。这里我们介绍一名 62 岁的女性，她在接受三阴性乳腺癌化疗时出现中性粒细胞减少性发热。她出现高烧，左大腿轻微疼痛，并伴有局部发红和硬结。随后，患者出现左手背疼痛和发红。初步结果表明蜂窝织炎，并立即开始静脉注射美罗培南进行经验性治疗。尽管接受了抗生素治疗，但随着局部感染的进展，患者很快出现感染性休克。紧急手术清创显示软组织广泛坏死，包括大腿广泛肌坏死。左手进行了广泛的清创，无法保留左下肢，需要将左髋关节离去。从微生物学角度来说，在不同的样品中分离出了败血梭菌，证实了气性坏疽。由于皮肤上没有局部入口，怀疑该中性粒细胞减少患者的肠易位导致血行播散。经验性抗生素治疗适合静脉注射青霉素，并辅以克林霉素以抑制毒素。经过彻底清创和抗生素治疗后，患者病情得以稳定。反复清创后伤口闭合，患者出院康复。抗生素治疗持续了四个星期。这一罕见的中性粒细胞减少患者气性坏疽病例显示了免疫功能低下患者坏死性软组织感染的诊断和治疗管理的复杂性。它特别强调了跨学科管理的重要性，包括快速识别疾病和快速（如果需要的话）彻底的手术清创以及量身定制的抗生素治疗，以取得成功的结果。© 2024。作者。

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.© 2024. The Author(s).