Iatrogenic Infection of Clostridium welchii Following Intramuscular Injection of Sodium Diclofenac
A 19-year-old male, presented to our hospital in September 2008, with severe pain in the right gluteal region. He gave the history of receiving an IM injection- diclofenac sodium from a local practitioner for viral fever and body ache. Within 7-8 h of receiving the injection, pain increased in intensity and radiated toward thigh, by 10-12 h he developed fever and pain increased in severity. He also had difficulty in walking. With the above features, he visited our hospital emergency department. On examination, patient had diffuse swelling with signs of inflammation in the upper posterior aspect of gluteal region there was no hematoma or local tissue damage and patient was febrile (102°F). Systemic examination was normal without other toxic symptoms at the time of admission. Various investigations showed Hb %-11g%, total WBC count-11,400 cells/mm3, Differential count-neutrophil-75%, lyphocytes-20%, monocyte-3%, and eosinophil-2%, ESR-35 mm/h. The diagnosis was injection site abscess and treated with systemic antibiotics (cephalosporin group) and antipyretics.\nWithin 24 h, patient developed toxic symptoms and had difficulty in moving the limb. Signs of inflammation spread to the lateral part of the thigh. On palpation, crepitus was present. Immediately X-ray of the part was taken which showed gas-filled sac near right hip joint []. Patient was immediately shifted to operation theater and wound debridement was done. Tissue bits were sent for Gram's stain and anerobic culture. Gram's stain revealed plenty of thick, Gram positive bacilli, and very few pus cells. Culture on Robertson's cooked meat media showed abundant gas which was foul smelling. Growth on neomycin blood agar showed grey colonies with swarming. Growth on egg yolk media showed opalescence around the colony. Nagler's reaction was positive which confirmed the organism as C. welchii.\nPostoperatively patient was started on systemic penicillin, ceftazidime, and metronidazole. Temperature and other vitals were regularly recorded which came to normal by the 8 postoperative day. Patient's general condition gradually improved and range of lower limb movements resumed thereafter. Patient went back home walking at the end of 30 days.