{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T01:51:02Z","timestamp":1775872262226,"version":"3.50.1"},"reference-count":17,"publisher":"Pensoft Publishers","issue":"1","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FM"],"abstract":"<jats:p>\n                    Gas gangrene, or clostridial myonecrosis, is a rare and life-threatening infection caused primarily by\n                    <jats:italic>Clostridium perfringens<\/jats:italic>\n                    . Despite its reduced incidence due to advancements in wound care and antibiotics, the disease remains associated with significant morbidity and mortality, particularly in immunocompromised individuals. This report presents a clinical case of a 37-year-old male with esophageal carcinoma and a totally implantable venous access device (Port-a-Cath), who developed fatal gas gangrene following chemotherapy.\n                  <\/jats:p>\n                  <jats:p>The patient presented with rapidly progressing symptoms, including fever, extensive edema, crepitus, and necrotic bullous lesions of the right upper limb and thoracic region. Despite prompt multidisciplinary evaluations and surgical intervention, the patient succumbed to infectious shock and cardiac arrest shortly after the initial incision. This case underscores the critical need for early clinical recognition of gas gangrene, especially by surgeons and emergency physicians, to initiate life-saving surgical debridement and adjunctive therapies.<\/jats:p>\n                  <jats:p>This report also highlights the interplay of modern medical devices with rare but catastrophic infections, emphasizing the necessity of vigilant monitoring and robust infection control protocols in high-risk patients. Through this unique presentation, we aim to enhance awareness and diagnostic acumen among healthcare professionals, advocating for interdisciplinary approaches and evidence-based guidelines to mitigate the devastating impact of gas gangrene in similar clinical contexts.<\/jats:p>","DOI":"10.3897\/folmed.68.e146721","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T09:45:20Z","timestamp":1772617520000},"source":"Crossref","is-referenced-by-count":1,"title":["Clinical case of a patient with fatal development of gas gangrene while using totally implantable venous access devices"],"prefix":"10.3897","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2477-6538","authenticated-orcid":true,"given":"Buryan","family":"Kirov","sequence":"first","affiliation":[{"name":"St George University Hospital, Plovdiv, Bulgaria"},{"name":"Medical University of Plovdiv, Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Plamen","family":"Murdzhanov","sequence":"additional","affiliation":[{"name":"St George University Hospital, Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angel","family":"Petkov","sequence":"additional","affiliation":[{"name":"St George University Hospital, Plovdiv, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2258","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"146721_B1","unstructured":"Present DA, Meislin R, Shaffer B. Gas gangrene. A review. Orthop Rev 1990; 19(4):333\u201341. PMID: 2185454."},{"key":"146721_B2","doi-asserted-by":"crossref","unstructured":"Srivastava I, Aldape MJ, Bryant AE, et al. Spontaneous C. septicum gas gangrene: A literature review. Anaerobe 2017; 48:165\u201371.","DOI":"10.1016\/j.anaerobe.2017.07.008"},{"key":"146721_B3","unstructured":"Shindo Y, Dobashi Y, Sakai T, et al. Epidemiological and pathobiological profiles of Clostridium perfringens infections: review of consecutive series of 33 cases over a 13-year period. Int J Clin Exp Pathol 2015; 8(1):569\u201377. PMC 4348875."},{"key":"146721_B4","doi-asserted-by":"crossref","unstructured":"Lehnhardt M, Homann HH, Daigeler A, et al. Major and lethal complications of liposuction: a review of 72 cases in Germany between 1998 and 2002. Plast Reconstr Surg 2008; 121(6):396e\u2013403e. PubMed: 18520866.","DOI":"10.1097\/PRS.0b013e318170817a"},{"key":"146721_B5","unstructured":"Buboltz JB, Murphy-Lavoie HM. Gas Gangrene. [Updated 2023 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK537030\/."},{"key":"146721_B6","unstructured":"Niederhuber JE, Ensminger W, Gyves JW, et al. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery 1982; 92:706\u201312."},{"key":"146721_B7","doi-asserted-by":"crossref","unstructured":"Biffi R, Toro A, Pozzi S, et al. Totally implantable vascular access devices 30 years after the first procedure. What has changed and what is still unsolved? Support Care Cancer 2014; 22:1705\u201314.","DOI":"10.1007\/s00520-014-2208-1"},{"key":"146721_B8","doi-asserted-by":"crossref","unstructured":"Silberzweig JE, Sacks D, Khorsandi AS, et al. Reporting standards for central venous access. Technology Assessment Committee. 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J Vasc Access 2018; 19(3):230\u201342.","DOI":"10.1177\/1129729818758999"},{"key":"146721_B12","unstructured":"Cancer Facts and Figures 2016 American Cancer Society; 2016. Available at: http:\/\/cancer.org\/research\/cancerfactsstatistics\/can cerfactsfigures2016\/. Accessed May 18, 2016."},{"key":"146721_B13","doi-asserted-by":"crossref","unstructured":"Di Carlo I, Pulvirenti E, Mannino M, et al. Increased use of percutaneous technique for totally implantable venous access devices. Is it real progress? A 27-year comprehensive review on early complications. Ann Surg Oncol 2010; 17(6):1649\u201356.","DOI":"10.1245\/s10434-010-1005-4"},{"key":"146721_B14","doi-asserted-by":"crossref","unstructured":"Tabatabaie O, Kasumova GG, Eskander MF, et al. Totally implantable venous access devices: a review of complications and management strategies. 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