Escherichia coliMyonecrosis in Alcoholic Cirrhosis

The risk of bacteremia in patients with cirrhosis increases with more advanced Child classification. Escherichia coliis the most frequently implicated organism in these bacteremic episodes. Unusually, E. colican produce a bullous cellulitis or myonecrosis. Two previous cases of E. coliassociated myonecrosis in patients with cirrhosis have been reported. We describe a third case in a cirrhotic patient with E. coliassociated bilateral lower extremity gas gangrene and review the existing literature. In the three patients with cirrhosis and E. colimyonecrosis, no obvious gastrointestinal perforation was found as the source of bacteremia. Intestinal edema due to portal hypertension is thought to have facilitated mucosal microperforations and bacteremia. Awareness of this unusual presentation may facilitate earlier diagnosis.