Photo Quiz: A fatal infectious case subsequent to pecking by a rooster

PHOTO QUIZ FIG 1 (A) The pecking wound on the right lower limb (at the red arrow).(B) Extensive severe damage of the right lower limb 2 days after the injury, the arrows point to ruptured bullae.(C) Multiple gram-positive bacilli in deep tissue effusion with Gram staining (1,000).(D) Colony morphology on the Colombian blood plate (Anaerobic culture for 48 h).A n 85-year-old male farmer presented with swelling, pain, and mobility impairment in the right limb after being pecked by a rooster 2 days before admission to our hospital (Fig. 1A).Panel A shows the pecking wound on the right lower limb at the red arrow).Following the peck injury, the minor wound without obvious redness or swelling was treated with disinfection and cephalexin at a local hospital but showed no improvement.He was transferred to our emergency department immediately due to the rapidly spreading pain and scattered small blisters on the right lower limb.Physical examination revealed extensive crepitation of the body and right lower limb; scattered exfoliative dermatitis with malodorous serosanguineous exudate; swelling of the perineum, scrotum, and the right lower limb with cyanosis; disappearance of pulsation of the right dorsalis pedis; and ochrodermia with scattered blood blisters (Fig. 1B).Imaging examination showed gas accumulation in multiple soft tissues, with loss of normal muscle tissue morphology.The patient received surgical debridement