Can be difficult - gas production is not universal and is generally absent in streptococcal disease.
Can follow minor or major trauma, especially when risk factors are present.
Maintain high index of suspicion when:
Patients are very ill from cellulitis (hypotension, septic shock)
Pain out of proportion to exam findings.
Anesthesia over affected area
Risk factors such as diabetes, recent surgery, or obesity
Findings such as skin necrosis or bullae
Putrid discharge with thin, “dishwater” pus
CT scan can help with diagnosis but if suspicion is moderate to high, surgical exploration is the preferred diagnostic test. DO NOT delay surgical intervention to obtain CT.
Initial histopathologic findings may be of prognostic importance. A poor neutrophil response with numerous organisms seen on routine stains implies a poor prognosis.