[Nonclostridial gas-producing phlegmone originating in the right thigh of a diabetic patient: report of a case with autopsy findings].

: A 49-year-old male with a history of diabetes mellitus of a period of twenty years noticed pain and feverish sensation in both thighs and both inguinal regions: they were more severe in the right than in the left. There were redness and swelling of the skins of the scrotum and of the superomedial aspects of both thighs. He had no diabetic ulcer on the right foot or right leg. Examination revealed evidence of gas retention in the subcutaneous tissue of the right thigh. Incision confirmed the presence of pus, from which Escherichia coli and Bacteroides fragilis were cultured. His condition gradually deteriorated despite wide incision, debridement, irrigation, and intensive chemotherapy. He expired on the 26th hospital day. Autopsy showed phlegmone of the right loin, right buttock, right thigh, and upper half of the right leg. We presume that the skin of the superomedial aspect of the right thigh was first infected. Bacteria rapidly invaded into the subcutaneous tissue; they induced phlegmone with gas production. We conclude that phlegmone of the right thigh simultaneously spread both to the right loin and right buttock, and to the right leg.