Introduction: This case reports Clostridium perfringens-induced gas gangrene and compartment syndrome after an intramuscular NSAID injection in an immunocompetent patient, an uncommon occurrence without typical risk factors. Despite limited access to advanced wound care, prompt surgical debridement, broad-spectrum antibiotics, and intensive support ensured survival.

Case presentation: A 37-year-old male developed severe pain, blackish skin discoloration, and rapidly progressing swelling of the right deltoid after receiving an intramuscular diclofenac injection. Within 24-30 h, he exhibited sepsis and compartment syndrome. Emergency fasciotomy and surgical debridement were performed, and cultures confirmed a polymicrobial infection, including Clostridium perfringens. He was treated with broad-spectrum antibiotics, intensive care, and serial debridement, leading to a gradual recovery. After three weeks of hospitalization, he was discharged in stable condition with follow-up for wound care and skin grafting.

Clinical discussion: Clostridial myonecrosis, or gas gangrene, is a fast-progressing, life-threatening infection. Strict aseptic techniques and cautious NSAID administration are crucial to prevent iatrogenic clostridial infections. Additionally, the lack of Negative Pressure Wound Therapy (NPWT) in resource-limited settings underscores disparities in wound care and the need for alternative management strategies. Further research is warranted to identify risk modifiers and improve early diagnostic markers for clostridial myonecrosis in immunocompetent patients.

Conclusion: Early recognition, immediate surgical intervention, and multidisciplinary management remain critical for survival. Improved awareness of sterile injection practices and diagnostic vigilance can help prevent and detect such rare but devastating infections.

Ismail MS, Fatima U, Ismail A, Khalid U. Case report on Clostridium perfringens-induced gas gangrene following an intramuscular injection: A stark reminder of injection-associated risks. Int J Surg Case Rep. 2025 Mar 29;130:111236. doi: 10.1016/j.ijscr.2025.111236. Epub ahead of print. PMID: 40174271.