Clostridium septicum Aortitis in a Patient with Colon Carcinoma

Abstract

Clostridium septicum is an anaerobic, spore-forming and toxin-producing gram-positive rod with peritrichous flagella. Septicemia due to this organism is severe and has an overall mortality rate of 33–64% [1, 2]. Clostridium septicum is a known cause of gas gangrene. However, the clinical importance of Clostridium septicum septicemia lies in its association with gastrointestinal or hematologic malignancy, with the most common site being adenocarcinoma of the right colon [3]. Vascular infection with Clostridium septicum has rarely been reported and might occur when circulating bacteria infect an atheromatous lesion during bacteremia [4, 5]. Here, we describe a patient with occult adenocarcinoma of the colon who presented with early-stage clostridial aortitis that progressed to an infected aneurysm. A 55-year-old man was admitted to hospital with abdominal pain and fever in August 2002. He had a 3year-history of primary biliary cirrhosis, and 20 years previously a seminoma had been treated with radiotherapy. On examination, he had a temperature of 38 C. The abdomen was tender with no palpable masses. Blood tests showed a raised leukocyte count of 13 103/mm3 with 75% neutrophils and 39% band forms, an elevated C-reactive protein level of 194 mg/l, and raised alkaline phosphatase of 235 U/l and gamma glutamyltransferase of 176 U/l. The hemoglobin concentration was 6.1 g/dl. Blood cultures grew an anaerobic rod identified as Clostridium septicum. Computed tomography (CT) showed an infrarenal periaortic mass (Fig. 1). The differential diagnosis included infectious aortitis, retroperitoneal lymphadenopathy, fibrosis, or neoplasm. Intravenous therapy with amoxicillin clavulanate and metronidazole was initiated, and the patient’s condition improved rapidly. Colonoscopy and CT revealed a large adenocarcinoma of the transverse colon. After 2 weeks of antibiotic therapy the transverse colon was surgically resected. Histology confirmed the presence of an ulcerating adenocarcinoma without lymph node involvement. An intraoperative periaortic lymph node biopsy showed

DOI: 10.1007/s10096-003-1009-0

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@article{Liechti2003ClostridiumSA, title={Clostridium septicum Aortitis in a Patient with Colon Carcinoma}, author={Matthias E. Liechti and Othmar Schoeb and G. M. Kacl and Basil Caduff}, journal={European Journal of Clinical Microbiology and Infectious Diseases}, year={2003}, volume={22}, pages={632-634} }