Nontraumatic clostridial myonecrosis

We describe three cases of nontraumatic clostridial myonecrosis seen at the Victorian Institute of Forensic Medicine. Nontraumatic clostridial myonecr osis is an uncommon and often fatal condition that requires immediate insti tution of appropriate medical and surgical therapy. It is most commonly cau sed by Clostridium perfringens and Clostridium septicum and is associated w ith gastrointestinal and hematologic malignancies, diabetes mellitus, and p eripheral vascular disease. The clinical features include a rapidly evolvin g acute illness with severe pain, marked tachycardia, and brawny discolorat ion of the skin with bullae formation and crepitus, followed by hypotension and acute renal failure. Features at autopsy include reddish brown skin di scoloration with bullae formation and necrotic skeletal muscle. Radiographs may be of use prior to the postmortem in detecting gas within the soft tis sues. Gram stain and microbiologic culture are important in establishing a definitive diagnosis; although the major factors in suggesting the diagnosi s are the recognition of the typical clinical history and macroscopic autop sy findings.