EMERGENCY CASEBOOKS
An unusual cause of chest pain: atraumatic clostridial myonecrosis
Stepping Hill Hospital, Stockport, South Manchester, UK
Correspondence to:
Dr D Horner, Booth Hall Children's Hospital, Charlestown Road, Blackley, Manchester M9 7AA, UK; danhorner{at}doctors.net.uk
Atraumatic clostridial myonecrosis is a rare but potentially life-threatening infective condition which is thought to occur in elderly and immunocompromised subjects via bacterial translocation through the gut wall and distant haematological seeding. Previous case reports have mainly focused on an association with malignancy and bowel inflammation. The case is reported of an 84-year-old woman initially treated for cardiac chest pain, with a medical history comprising only of type 2 diabetes, hypertension and monoclonal gammopathy of unknown significance. Chest pain remains a common presentation to all emergency departments worldwide and, with increasing pressure for early intervention in cardiac causes, prehospital treatment is becoming more commonplace. Clinicians must be sure to make a thorough initial assessment and take care when prescribing cardiac medications for chest pain, owing to the vast spectrum of differential diagnoses.
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