Summary

A 57-year-old woman with non-Hodgkin's lymphoma presented to the emergency department with febrile neutropaenia. She complained of fever and malaise and had a normal physical examination. Ten hours later, she developed worsening right leg pain that required escalating doses of morphine. Her physical examination remained unremarkable. Owing to the increasing pain in her leg, an x-ray was performed which revealed subcutaneous emphysema. She subsequently developed numbness over her right leg and, then, 21 h after admission the leg became cold and ischaemic. Haemorrhagic bullae and bruising began to form and crepitus was palpated. She was taken to the operating room where debridement was attempted, but the surgeons found deep and extensive tissue necrosis. She was transferred to the intensive care unit for a trial of medical therapy and eventual palliation. The pathology revealed severe myonecrosis secondary to Clostridium septicum. She expired 36 h after presentation.