SPONTANEOUS CLOSTRIDIUM-SEPTICUM MYONECROSIS IN CONGENITAL NEUTROPENIA

Spontaneous Clostridium septicum myonecrosis is an uncommon disorder t hat has been described in association with malignancy, immunosuppressi on and neutropaenia. Typical clostridial myonecrosis develops without a visible portal of entry and mortality is high. The pathogenesis is n ot completely understood but the clostridia may gain access to the cir culation via areas of ileo-caecal ulceration secondary to enterocoliti s, antibiotics or neoplasms. A 5 year old boy with congenital neutropa enia presented with spontaneous Clostridium septicum myonecrosis in th e thigh. Limb salvage was achieved using antibiotics, hyberbaric oxyge nation and selective debridement. The portal of entry may have been th e gastrointestinal tract as colonic ulceration may occur in neutropaen ia, and pre-morbid clindamycin administration may have encouraged over growth of colonic clostridia.