Beruflich Dokumente
Kultur Dokumente
CASE REPORT
Blackwell Publishing Asia
ABSTRACT
Our patient was a 37-year-old man with diabetes mellitus and hepatopathy as underlying diseases. Swelling,
erythema and pain appeared in the left upper limb on the day before the initial examination. On examination, diffuse
purpura was noted on the left upper limb, and, as it rapidly extended to the left upper trunk, emergency surgery
was performed. Intraoperatively, gas-producing necrosis was observed not only in subcutaneous tissues but also
from the fascia to muscle tissues, and the condition resembled clostridial gas gangrene. However, as the culturing
of samples from the lesion yielded Bacillus cereus, a diagnosis of necrotizing fasciitis and myonecrosis (synergistic
necrotizing cellulitis) due to B. cereus was made. While the patient developed a serious condition due to sepsis
and disseminated intravascular coagulation, he could be saved by early debridement and intensive treatment with
an appropriate selection of antibiotics.
Key words: Bacillus cereus, necrotizing fasciitis, myonecrosis.
Correspondence: Asuka Sada, M.D., Division of Dermatology, Department of Internal Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga 849-8501,
Japan. Email: sadaasu@cc.saga-u.ac.jp
Received: 19 December 2008; accepted: 11 March 2009.
3 Tuazon CU. Other Bacillus species. In: Mandell GL, treatment of brain abscess and necrotizing fasciitis
Benett JE, Dolin R, eds. Mandell, Douglas and Benett’s caused by Bacillus cereus. Intern Med 2002; 41: 671–673.
Principles and Practice of Infectious Diseases, 5th edn. 9 Turnbull PCB, French TA, Dowsett EG. Severe systemic
New York: Churchill Livingstone. 2000; 2220–2226. and pyogenic infections with Bacillus cereus. Br Med J
4 Khavari PA, Bolognia JL, Eisen R, Edberg SC, Grimshaw 1977; 25: 1628–1629.
SC, Shapiro PE. Periodic acid-Schiff-positive organisms 10 Fitzpatrick DJ, Turnbull PCB, Keane CT, English LF.
in primary cutaneous Bacillus cereus infection. Arch Two gas-gangrene-like infections due to Bacillus
Dermatol 1991; 127: 543–546. cereus. Br J Surg 1979; 66: 577–579.
5 Meredith FT, Fowler VG, Gautier M, Corey GR, Reller 11 Johnson DA, Aulicino PL, Newby JG. Bacillus cereus-
LB. Bacillus cereus necrotizing cellulitis mimicking induced myonecrosis. J Trauma 1984; 24: 267–270.
clostridial myonecrosis: case report and review of the 12 Darbar A, Harris IA, Gosbell IB. Necrotizing infection
literature. Scand J Infect 1997; 29: 528–529. due to Bacillus cereus mimicking gas gangrene follow-
6 Henrickson KJ, Shenep JL, Flynn PM, Pui CH. Primary ing penetrating trauma. J Orthop Trauma 2005; 19:
cutaneous Bacillus cereus infection in neutropenic 353–355.
children. Lancet 1989; 1: 601–603. 13 Swaetz MN, Pasternack MS. Cellulitis and subcutaneous
7 Guiot HF, de Planque MM, Richel DJ, van’t Wout JW. tissue infections. In: Mandell GL, Bennett JE, Dolin R,
Bacillus cereus: a snake in the grass for granulocyto- eds. Principles and Practice of Infectious Diseases, 6th
penic patients. J Infect Dis 1986; 153: 1186. edn. New York: Churchill Livingstone. 2006; 1172–
8 Mori T, Tokuhira M, Takae Y et al. Successful non-surgical 1191.