{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:51:09Z","timestamp":1753876269258,"version":"3.41.2"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T00:00:00Z","timestamp":1672617600000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Clostridium perfringens is a well-known cause of gas gangrene with a very high mortality rate. Multiple cases of internal organs have been reported in the literature; however, non-traumatic spontaneous gas gangrene due to C. perfringens with solely cardiac involvement in a patient without any risk factors has not been reported before.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case Summary<\/jats:title>\n                  <jats:p>A 52-year-old male presented to the emergency department with chest pain and exertional dyspnoea for three days. The patient was haemodynamically stable initially, and the physical examination was unremarkable. Initial laboratory workup revealed elevated D-dimer and troponin levels. Computerized tomography (CT) of the chest was negative for pulmonary embolism but showed a hypodense focus in the cardiac silhouette. Acute coronary syndrome protocol was initiated; however, invasive cardiac workup was negative. The patient had rapid clinical deterioration with development of respiratory failure, shock, and multiorgan failure within 24\u2005h. A transesophageal echocardiogram demonstrated an abnormal echogenic focus, corresponding to CT chest area. Despite aggressive treatment, the patient passed away within 36\u2005h. Later, the patient\u2019s blood culture grew C. perfringens. A limited autopsy showed an abscess cavity in the interventricular septum, pathology of which revealed acute myocarditis and fibrinous pericarditis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Unlike other reported cases of C. perfringens with cardiac abscess, our patient had no known risk factors, and no other organs were involved. We conclude from this case that an air focus on the CT scan in the myocardium can be suggestive of a spontaneous gas gangrene of the myocardium, and the patients should be treated accordingly.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytac488","type":"journal-article","created":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T18:32:10Z","timestamp":1672684330000},"source":"Crossref","is-referenced-by-count":0,"title":["Gas in the myocardium: a fatal presentation of <i>Clostridium perfringens<\/i>: a case report"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9671-3261","authenticated-orcid":false,"given":"Hafiz Muhammad Waqas","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Disease, Michigan State University\/McLaren , Flint, MI 48532 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amman","family":"Yousaf","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Michigan State University\/McLaren , Flint, MI 48532 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Michigan State University\/McLaren , Flint, MI 48532 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5877-4725","authenticated-orcid":false,"given":"Hameem U","family":"Changezi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease, Michigan State University\/McLaren , Flint, MI 48532 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,1,2]]},"reference":[{"key":"2023012703310938600_ytac488-B1","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1186\/s12879-019-4350-3","article-title":"Type A fulminant Clostridium perfringens sepsis indicated RBC\/Hb discrepancy; a case report","volume":"19","author":"Sakaue","year":"2019","journal-title":"BMC Infect Dis"},{"key":"2023012703310938600_ytac488-B2","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.2169\/internalmedicine.49.4041","article-title":"Clinical and epidemiological features of Clostridium perfringens bacteremia: a review of 18 cases over 8 year-period in a tertiary care center in metropolitan Tokyo area in Japan","volume":"49","author":"Fujita","year":"2010","journal-title":"Intern Med"},{"key":"2023012703310938600_ytac488-B3","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0300-9572(03)00121-7","article-title":"Gas gangrene pyaemia with myocardial abscess formation\u2013fatal outcome from a rare infection nowadays","volume":"58","author":"Keese","year":"2003","journal-title":"Resuscitation"},{"key":"2023012703310938600_ytac488-B4","doi-asserted-by":"crossref","first-page":"S93","DOI":"10.1086\/341928","article-title":"The role of clostridial toxins in the pathogenesis of gas gangrene","volume":"35","author":"Stevens","year":"2002","journal-title":"Clin Infect Dis"},{"key":"2023012703310938600_ytac488-B5","doi-asserted-by":"crossref","first-page":"960","DOI":"10.5152\/tjg.2020.19987","article-title":"Clostridium perfringens bacteremia associated with colorectal cancer in an elderly woman","volume":"31","author":"Huang","year":"2020","journal-title":"Turk J Gastroenterol"},{"key":"2023012703310938600_ytac488-B6","first-page":"165","article-title":"Gas gangrene caused by Clostridium perfringens involving the liver, spleen, and heart in a man 20 years after an orthotopic liver transplant: a case report","volume":"12","author":"Kitterer","year":"2014","journal-title":"Exp Clin Transplant"},{"key":"2023012703310938600_ytac488-B7","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/0002-8703(67)90006-3","article-title":"Gas gangrene of the heart in Clostridial septicemia","volume":"74","author":"Roberts","year":"1967","journal-title":"Am Heart J"},{"key":"2023012703310938600_ytac488-B8","first-page":"2828","volume-title":"Principles and Practice of Infectious Diseases","author":"Lorber","year":"2005","edition":"6th ed"},{"key":"2023012703310938600_ytac488-B9","first-page":"274","article-title":"Spontaneous clostridial myonecrosis. 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