Vol.97 No.7 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 97 No. 7 July 2004
A Case of Neck Gas Gangrene with Iodoform Poisoning
Yumiko Maruyama and Kazuhira Endo
(Kurobe City Hospital)
Toshiaki Tsukatani and Mitsuru Furukawa
(Kanazawa University Graduate School of Medicine)
A case of iodoform toxicity is presented in a patient after the treatment of neck gas gangrene. Although iodoform has been widely used for the treatment of wounds, there are few case reports about its side effects, such as headache, consciousness disturbance, delirium and tachycardia. We describe a 56-year-old blind male who under-went hemodialysis for chronic renal failure, with neck gas gangrene. Nonclostridial gas gangrene of the deep neck was improved by surgical drainage and wide debridment of necrotic tissue in combination with conservative treatment. Four kinds of anaerobic gram-positive bacteria including Peptostreptococcus micros were detected in pus. After surgical treatment, we used iodoformgauze (0.22 g/day) in the open wounds of the neck. Two days after the iodoform application, he became confused, then delirius. Total serum iodine concentration was high (7440 mg/dl; normal range, 4.0 to 9.0 mg/dl). To our knowledge, this value of iodine concentration is the highest of the previous patients reported as having iodoform poisoning. We stopped iodoform use and performed direct hemoperfusion, which was considered effective to reduce total serum iodine. The patient became conscious, and was discharged 46 days after hospitalization.
Key words : neck gas gangrene, iodoform poisoning, delirium, chronic renal failure, direct hemoperfusion