Two days after hospital admission and surgical treatment for a cut on his right thigh from a sickle, a 35-year-old man presents to the emergency department with wound swelling, fever, chills, and severe pain. He had a similar injury 4 months ago that resolved after treatment with bacitracin ointment and daily dressings. He works on a farm on the outskirts of the city. He appears anxious. His temperature is 38.5°C (101.3°F), pulse is 103/min, and blood pressure is 114/76 mm Hg. Examination shows a 6-cm edematous deep, foul-smelling wound on the medial surface of the right thigh. The skin over the thigh appears darker than the skin on the lower leg. There are multiple blisters around the wound. Light palpation around the wound causes severe pain; crepitus is present. Gram staining of the bullae fluid reveals numerous gram-positive rods, and subsequent culture grows Clostridium septicum. Which of the following is the greatest risk factor for this patient's current condition?

Question

Two days after hospital admission and surgical treatment for a cut on his right thigh from a sickle, a 35-year-old man presents to the emergency department with wound swelling, fever, chills, and severe pain. He had a similar injury 4 months ago that resolved after treatment with bacitracin ointment and daily dressings. He works on a farm on the outskirts of the city. He appears anxious. His temperature is 38.5°C (101.3°F), pulse is 103/min, and blood pressure is 114/76 mm Hg. Examination shows a 6-cm edematous deep, foul-smelling wound on the medial surface of the right thigh. The skin over the thigh appears darker than the skin on the lower leg. There are multiple blisters around the wound. Light palpation around the wound causes severe pain; crepitus is present. Gram staining of the bullae fluid reveals numerous gram-positive rods, and subsequent culture grows Clostridium septicum.  Which of the following is the greatest risk factor for this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Clostridium septicum is a spore-forming, exotoxin-producing, gram-positive organism that is the most common cause of spontaneous gas gangrene (eg, rapid-onset pain, hemorrhagic bullae, tissue crepitus).  Underlying colonic malignancy is the greatest risk factor for infection.

Two Days After Hospital Admission and Surgical Treatment for a Cut