A case of non-clostridial gas gangrene at the site of a sacral pressure ulcer

We report a case of non-clostridial gas gangrene that developed from a decubitus ulcer overlying the left ischial tuberosity. A 47-year-old woman with paraplegia secondary to multiple sclerosis presented with fever associated with a sacral pressure ulcer of several weeks duration. The patient had been confined to a wheelchair for several years and did not seek medical attention when the pressure ulcer developed several weeks before. Tissue necrosis was observed at the ulcer site and computed tomography revealed gas in the left gluteal muscles and the lower left leg. A diagnosis of gas gangrene was made, and antibiotics were started. However, the fever continued and surgical debridement was performed. Bacterial cultures yielded Enterococcus avium and Lactobacillus sp. Multiple skin grafts and a gluteus maximus myocutaneous flap were needed to cover the skin defect. No recurrence of the ulcer has occurred.