Epinephrine auto-injection radically increases risk for clostridial infection and necrotizing fasciitis


Submitted: 30 August 2016
Accepted: 21 March 2017
Published: 28 April 2017
Abstract Views: 1960
PDF: 658
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Authors

Clostridial perfringens is a bacteria commonly found on skin flora. Due to the optimal growth environment intramuscular epinephrine injections predispose patients to the rapid development of clostridial myonecrosis. There have been only four cases, including this one, reported in the last 60 years of pediatric Clostridium perfringens infections post-epinephrine injection. We detail the successful management of a 16 year old, immunocompetent female who developed gas gangrene and necrotizing fasciitis on her thigh secondary to clostridial infection after utilization of an Epinephrine Auto-Injector and review the pediatric literature of patients with Clostridial perfringens secondary to epinephrine injection. We define common clinical signs and symptoms of clostridial infection from the review of the literature. The relevance of our findings is to raise awareness among emergency physicians when patients present following an injection in order to reduce diagnostic delay that could result in amputation or death.

Kenneth Larson, Trauma & Burn Surgery Center, Mercy Hospital, Springfield, MO

General and Trauma Surgery, MD, FACS

Gary Grone, Department of Trauma Services, Mercy Hospital, Springfield, MO
Trauma Nurse Clinician, BSN
Cindy L. Austin, Trauma & Burn Research, Mercy Hospital, Springfield, MO
Trauma and Burn Research Scientist
Simon J. Thompson, Trauma & Burn Research, Mercy Hospital, Springfield, MO
Trauma & Burn, Senior Research Scientist

Supporting Agencies

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Larson, K., Grone, G., Austin, C. L., & Thompson, S. J. (2017). Epinephrine auto-injection radically increases risk for clostridial infection and necrotizing fasciitis. Emergency Care Journal, 13(1). https://doi.org/10.4081/ecj.2017.6256

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