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Results of blood culture. Anaerobic gram-positive bacilli with short and club-shaped rods, often showing bifurcation. Identification of the species from morphological features alone was not possible.
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Table). The blood culture yielded positive results for gram-positive bacilli under anaerobic conditions (Fig. 1).
Results of 16 S rDNA analysis. A) Base sequence of the sample from the patient. B) Base sequence of the sample shows 98 % concordance with Bifidobacterium breve.
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Mass spectrography and 16 S rDNA analysis confirmed B. breve (Fig. 2).
Plain CT taken on hospital day 1, (A) Horizontal section of the pelvic CT shows gas in the adipose tissue of the right inguinal region (arrow). CT attenuation value of the subcutaneous adipose tissue is increased around the gas. These findings are consistent with necrotizing fasciitis. (B) Horizontal section of the CT at the level of the femoral head shows widespread gas around the right gluteus medius muscle and the right iliacus muscle (arrows). (C) Coronal section of the CT shows widespread gas from the inside of the right femur to subcutaneous tissue over the superior anterior iliac spine, and from the muscles around the right femur to the right iliopsoas muscle (arrows). (D) Sagittal section of the CT shows widespread gas from front of the right quadriceps femoral muscle to the right iliopsoas muscle (arrows).
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Computed tomography (CT) of the lower limb showed widespread gas (Fig. 3).