Clostridium septicum Pneumocephalus

Clostridium septicum brain abscess

We present a previously well woman in her 70s who was admitted for 2 weeks of progressively worsening abdominal pain, high fever and drowsiness. She was eventually diagnosed with Clostridium septicum brain abscess, meningoencephalitis and ventriculitis. The diagnosis was challenging as cerebrospinal fluid cultures were negative and a microbiological diagnosis was only obtained on brain biopsy. Despite early initiation of antibiotics that would have been effective against C. septicum, her central nervous system (CNS) infection progressed, and she eventually succumbed to the infection. Infections with C. septicum are typically fulminant and associated with high mortality. In a patient with a CNS infection and concomitant abdominal manifestations, infection with C. septicum should be considered.

Intestinal infection leads to hepatic portal venous gas

Hepatic portal venous gas (HPVG) is a rare imaging features, we report a case of HPVG induced by intestinal infection.

Probable Clostridium septicum pneumocephalus in a user of natural remedies with newly diagnosed diabetes mellitus type 1

Clostridium septicum encephalitis is a rare cause of spontaneous, non-traumatic pneumocephalus. Systemic infections with this organism have a fulminant course, likely leading to death within 48 hours, and are commonly associated with hematological or colonic malignancies. The effectiveness of an antibacterial regimen is unknown because of a lack of studies. The best prognosis is observed in patients undergoing early surgical intervention for localized intracranial processes. Here we describe a case of rapidly developing C. septicum sepsis as a result of bacteremia and hematogenous spread, resulting in encephalitis and pneumocephalus in a patient without a diagnosed malignancy. The patient presented to the emergency department with diabetic ketoacidosis, which led to the diagnosis of new-onset type 1 diabetes mellitus. There are currently 19 reported cases of C. septicum central nervous system infections in the literature, with 12 of them having pneumocephalus. Natural remedies, such as drinking kombucha tea and performing coffee enemas, that were used by our patient may have played a role in the dissemination of C. septicum. In survivors of this fulminant illness, colonic and hematologic malignancies should be excluded because of their association with such infections. Type 1 diabetes mellitus, drinking kombucha tea, and performing coffee enemas may be newly recognized risk factors associated with the dissemination of C. septicum.

Ischaemic stroke and Clostridium septicum sepsis and meningitis in a patient with occult colon carcinoma - a case report and review of the literature

Background

Clostridium septicum is a rare cause of meningitis and brain abscess in children and adults. Gas production by the pathogen can lead to pneumocephalus and the overall mortality rate of Clostridium septicum CNS infection is as high as 74%. The most common entry site of the pathogen is the gastrointestinal tract.

Case presentation

We describe a 74-year-old man who presented with a left-sided cerebral infarction in the middle cerebral artery territory. In addition the patient showed signs of Systemic Inflammatory Response Syndrome and Disseminated Intravascular Coagulation. Examination of blood cultures and cerebrospinal fluid led to the diagnosis of sepsis and meningitis caused by Clostridium septicum. Despite appropriate antibiotic therapy the condition of the patient deteriorated rapidly and he died on day 2 after admission. Autopsy revealed a previously unknown adenocarcinoma of the colon ascendens as entry site of the pathogen.

Conclusion

Clostridium septicum should be considered as potential pathogen in patients with sepsis and meningitis. Gram stain morphology in conjunction with severe sepsis can rapidly point into the direction of this pathogen. CNS infections manifest either as meningoencephalitis/cerebritis or as brain abscess. Entry site of the pathogen is almost uniquely the gastrointestinal tract. In adults more than 50% suffer from colorectal carcinoma, therefore survivors of Clostridium septicum infections should be examined for underlying occult colorectal malignancy.