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Epinephrine Auto-Injection After Allergic Reaction Leading to Gas Gangrene of the Leg

Vincent Peyko, Darius Shams, Allison R. Lauver

(Department of Pharmacy, Mercy Health – St. Elizabeth Boardman Hospital, Boardman, OH, USA)

Am J Case Rep 2021; 22:e930889

DOI: 10.12659/AJCR.930889

BACKGROUND: Clostridial myonecrosis, also known as gas gangrene, is a highly lethal necrotizing soft tissue infection. While commonly associated with trauma, clostridial myonecrosis may be the result of parenteral injection of medications. Epinephrine is the most commonly reported medication leading to gas gangrene.
CASE REPORT: A 60-year-old man presented to the Emergency Department (ED) with “the worst pain in his life” to the right thigh near the site at which he auto-injected epinephrine after multiple bee stings 10-11 h prior to arrival. Initial heart rate was 112 beats/min but all other vital signs were unremarkable at presentation. Due to extreme pain, a computed tomography (CT) scan was ordered, revealing prominent gas within the anterior compartment of the right thigh, mostly involving the vastus lateralis and rectus femoris, suggesting necrotizing fasciitis. Antimicrobials were initiated immediately and the patient was taken for surgical debridement within 70 min after obtaining the CT results. Clostridium perfringens was cultured from the patient’s tissue. After several surgical debridement’s, appropriate antimicrobial therapy, supportive care, and wound care, the patient’s limb remained intact and he was discharged after 11 days.
CONCLUSIONS: With millions of epinephrine auto-injectors prescribed yearly in the United States, awareness of clostridial gas gangrene following epinephrine auto-injection for the provider may help guide decision-making in patients presenting with extreme pain, redness, or swelling near the injection site after epinephrine injection.

Keywords: Clostridium perfringens, Epinephrine, Gas Gangrene

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
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