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Brandlmaier M, Hoellwerth M, Papadopoulos D, Koelblinger P. Blasenbildendes Erythem an der rechten Schulter. J Dtsch Dermatol Ges 2024; 22:1175-1178. [PMID: 39105223 DOI: 10.1111/ddg.15474_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/28/2024] [Indexed: 08/07/2024]
Affiliation(s)
- Matthias Brandlmaier
- Universitätsklinik für Dermatologie und Allergologie, Paracelsus Medizinische Universität, Salzburg, Österreich
| | - Magdalena Hoellwerth
- Universitätsklinik für Dermatologie und Allergologie, Paracelsus Medizinische Universität, Salzburg, Österreich
| | - Demetrios Papadopoulos
- Universitätsklinik für Dermatologie und Allergologie, Paracelsus Medizinische Universität, Salzburg, Österreich
| | - Peter Koelblinger
- Universitätsklinik für Dermatologie und Allergologie, Paracelsus Medizinische Universität, Salzburg, Österreich
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Chirikian D, Awsare S, Fitzgibbon J, Lee L. Concurrent Clostridium septicum bacteremia and colorectal adenocarcinoma with metastasis to the brain - A Case Report. IDCases 2021; 25:e01189. [PMID: 34189038 PMCID: PMC8220233 DOI: 10.1016/j.idcr.2021.e01189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 06/10/2021] [Indexed: 01/05/2023] Open
Abstract
There is a known relationship between Clostridium septicum bacteremia and colorectal malignancies. C. septicum is a gram-positive, anaerobic, spore-forming bacterium that can survive the acidic colorectal tumor microenvironment, where it is thought to enter the blood by tumor-mediated epithelial tissue damage. While in circulation, C. septicum can release exotoxins which may lead to life-threatening sepsis. The patient in this case presented with a mild fever, abdominal pain, and left hand weakness. Imaging of the head and abdomen revealed a right frontal lucency and wall thickening of the ascending colon. Two colonic adenocarcinomas were found and removed via an exploratory laparotomy and right hemicolectomy. The blood culture was positive for C. septicum. Brain MRI confirmed a right frontal mass concerning for metastasis. Here, we discuss the relationship between colonic cancers and Clostridium septicum bacteremia.
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Affiliation(s)
- David Chirikian
- California Northstate University College of Medicine, 9700 West Taron Drive, Elk Grove, CA, 95757, USA
| | - Sohun Awsare
- California Northstate University College of Medicine, 9700 West Taron Drive, Elk Grove, CA, 95757, USA
| | - John Fitzgibbon
- California Northstate University College of Medicine, 9700 West Taron Drive, Elk Grove, CA, 95757, USA
| | - Lenora Lee
- Department of Infectious Disease, Kaiser Permanente Sacramento Medical Center, 2025 Morse Avenue, Sacramento, CA, 95825, USA
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Sidhu JS, Mandal A, Virk J, Gayam V. Early Detection of Colon Cancer Following Incidental Finding of Clostridium septicum Bacteremia. J Investig Med High Impact Case Rep 2020; 7:2324709619832050. [PMID: 30857430 PMCID: PMC6415464 DOI: 10.1177/2324709619832050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Clostridium septicum is a Gram-positive, anaerobic, spore-forming bacillus found in the intestine. It is linked to colon cancer and immunosuppression. Infection with C septicum may vary in manifestation and is associated with more than 60% mortality rate. In this article, we present a case of incidental isolation of C septicum in a patient who presented with fever and later on colonoscopy was found to have colon carcinoma. Bacteremia may be the unexpected initial presentation of undiagnosed colon carcinoma.
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Affiliation(s)
| | | | | | - Vijay Gayam
- 1 Interfaith Medical Center, Brooklyn, NY, USA
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Cullinane C, Earley H, Tormey S. Deadly combination: Clostridium septicum and colorectal malignancy. BMJ Case Rep 2017; 2017:bcr-2017-222759. [PMID: 29197851 DOI: 10.1136/bcr-2017-222759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Gas gangrene is a life-threatening, necrotising soft tissue infection. Colorectal malignancy-associated Clostridiumsepticum is a rare cause of gas gangrene. This case outlines an initial presentation of colonic malignancy as gas gangrene from C.septicum infection.A 69-year-old man presented with abdominal pain, vomiting and constipation. Abdominal X-ray revealed dilated small bowel loops. Lactate was elevated. A diagnosis of small bowel obstruction was made. Subsequent CT revealed caecal thickening and subcutaneous emphysema overlying the left flank. Clinically, he became haemodynamically unstable. Examination revealed crepitus overlying the left flank in keeping with gas gangrene. The patient required immediate surgical debridement. Tissue specimens cultured C.septicum Following a complicated postoperative period, he was transferred to the plastic surgery team for further tissue debridement and reconstruction. A colonoscopy was later performed which was suspicious for malignancy. Colorectal multidisciplinary team discussion is awaited.
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Affiliation(s)
- Carolyn Cullinane
- General Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Helen Earley
- General Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Shona Tormey
- General Surgery, University Hospital Limerick, Limerick, Ireland
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Ito F, Inokuchi R, Matsumoto A, Kumada Y, Yokoyama H, Ishida T, Hashimoto K, Narita M, Shinohara K. Presence of periaortic gas in Clostridium septicum-infected aortic aneurysm aids in early diagnosis: a case report and systematic review of the literature. J Med Case Rep 2017; 11:268. [PMID: 28931420 PMCID: PMC5607595 DOI: 10.1186/s13256-017-1422-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clostridium septicum-infected aortic aneurysm is a fatal and rare disease. We present a fatal case of C. septicum-infected aortic aneurysm and a pertinent literature review with treatment suggestions for reducing mortality rates. CASE PRESENTATION A 58-year-old Japanese man with an unremarkable medical history presented with a 3-day history of mild weakness in both legs, and experienced paraplegia and paresthesia a day before admission. Upon recognition of signs of an abdominal aortic aneurysm and paraplegia, we suspected an occluded Adamkiewicz artery and performed a contrast-enhanced computed tomography scan, which revealed an aortic aneurysm with periaortic gas extending from his chest to his abdomen and both kidneys. Antibiotics were initiated followed by emergency surgery for source control of the infection. However, owing to his poor condition and septic shock, aortic repair was not possible. We performed bilateral nephrectomy as a possible source control, after which we initiated mechanical ventilation, continuous hemodialysis, and hemoperfusion. A culture of the samples taken from the infected region and four consecutive blood cultures yielded C. septicum. His condition gradually improved postoperatively; however, on postoperative day 10, massive hemorrhage due to aortic rupture resulted in his death. CONCLUSIONS In this patient, C. septicum was thought to have entered his blood through a gastrointestinal tumor, infected the aorta, and spread to his kidneys. However, we were uncertain whether there was an associated malignancy. A literature review of C. septicum-related aneurysms revealed the following: 6-month mortality, 79.5%; periaortic gas present in 92.6% of cases; no standard operative procedure and no guidelines for antimicrobial administration established; and C. septicum was associated with cancer in 82.5% of cases. Thus, we advocate for early diagnosis via the identification of periaortic gas, as an aortic aneurysm progresses rapidly. To reduce the risk of reinfection as well as infection of other sites, there is the need for concurrent surgical management of the aneurysm and any associated malignancy. We recommend debridement of the infectious focus and in situ vascular graft with omental coverage. Postoperatively, orally administered antibiotics must be continued indefinitely (chronic suppression therapy). We believe that these treatments will decrease mortality due to C. septicum-infected aortic aneurysms.
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Affiliation(s)
- Fumihito Ito
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
| | - Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, JR General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan.,Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akinori Matsumoto
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Yoshibumi Kumada
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Hideyuki Yokoyama
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Tokiya Ishida
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Katsuhiko Hashimoto
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Masashi Narita
- Department of Infectious Diseases, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, 904-2293, Japan
| | - Kazuaki Shinohara
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
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Implications of Clostridium septicum in Vascular Surgery: A Case Report and Outcomes Literature Review. Ann Vasc Surg 2017; 43:314.e5-314.e11. [DOI: 10.1016/j.avsg.2017.03.178] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/28/2017] [Indexed: 11/22/2022]
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Søgaard KK, Farkas DK, Søgaard M, Schønheyder HC, Thomsen RW, Sørensen HT. Gram-negative bacteremia as a clinical marker of occult malignancy. J Infect 2016; 74:153-162. [PMID: 27838520 DOI: 10.1016/j.jinf.2016.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 09/19/2016] [Accepted: 09/28/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Gram-negative bacteremia may be a harbinger of occult cancer. We examined the risk of cancer following hospitalization with bacteremia. METHODS Using medical databases, we conducted a nationwide population-based cohort study of all Danes with a discharge diagnosis of Gram-negative bacteremia during 1994-2013. We calculated absolute risks and standardized incidence ratios (SIRs) of cancer, comparing the observed risk to that expected in the general population. RESULTS We observed 1379 cancers vs. 988 expected among 11,753 patients with Gram-negative bacteremia, corresponding to an overall SIR of 1.40 (95% confidence interval (CI): 1.32-1.47). During the first 6 months following the bacteremia diagnosis, the SIR for cancer was 3.33-fold (95% CI: 2.99-3.69) increased, corresponding to an absolute risk of 3.05%. The increased risk stemmed mainly from higher than expected occurrence of gastrointestinal cancer (3- to 13-fold higher), genitourinary cancer (4- to 10-fold higher), non-Hodgkin lymphoma (5-fold higher), non-specified metastatic cancer (5-fold higher), and breast and lung cancer (2-fold higher). The 6-12 months SIR for any cancer was 1.46 (95% CI: 1.22-1.72), and beyond 1 year of follow-up, the SIR declined to 1.13 (95% CI: 1.05-1.20). CONCLUSIONS Gram-negative bacteremia is a clinical marker of occult cancer.
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Affiliation(s)
- Kirstine K Søgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark.
| | - Dóra K Farkas
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Mette Søgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Henrik C Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
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Griffin AS, Crawford MD, Gupta RT. Massive gas gangrene secondary to occult colon carcinoma. Radiol Case Rep 2016; 11:67-9. [PMID: 27257452 PMCID: PMC4878939 DOI: 10.1016/j.radcr.2016.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 02/04/2016] [Indexed: 11/17/2022] Open
Abstract
Gas gangrene is a rare but often fatal soft-tissue infection. Because it is uncommon and the classic symptom of crepitus does not appear until the infection is advanced, prompt diagnosis requires a high index of suspicion. We present a case report of a middle-aged man who presented with acute onset lower-extremity pain that was initially thought to be due to deep vein thrombosis. After undergoing workup for pulmonary embolism, he was found to have massive gas gangrene of the lower extremity secondary to an occult colon adenocarcinoma and died within hours of presentation from multisystem organ failure.
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Affiliation(s)
- Andrew S Griffin
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC 27710, USA
| | - Matthew D Crawford
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3956, Durham, NC 27710, USA
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, DUMC Box 3808, Durham, NC 27710, USA
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Clostridium septicum Gas Gangrene in Colon Cancer: Importance of Early Diagnosis. Case Rep Infect Dis 2015; 2015:694247. [PMID: 26793397 PMCID: PMC4697071 DOI: 10.1155/2015/694247] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/29/2015] [Indexed: 02/06/2023] Open
Abstract
The Clostridia species are responsible for some of the deadliest diseases including gas gangrene, tetanus, and botulism. Clostridium septicum is a rare subgroup known to cause atraumatic myonecrosis and is associated with colonic malignancy or immunosuppression. It is a Gram-positive, anaerobic, spore-forming bacillus found in the gastrointestinal tract and can lead to direct, spontaneous infections of the bowel and peritoneal cavity. The anaerobic glycolysis of the tumor produces an acidic, hypoxic environment favoring germination of clostridial spores. Tumor-induced mucosal ulceration allows for translocation of sporulated bacteria from the bowel into the bloodstream, leading to fulminant sepsis. C. septicum bacteremia can have a variable presentation and is associated with greater than 60% mortality rate. The majority of deaths occur within the first 24 hours if diagnosis and appropriate treatment measures are not promptly started. We report a case of abdominal myonecrosis in a patient with newly diagnosed colon cancer. The aim of this study is to stress the importance of maintaining a high suspicion of C. septicum infection in patients with underlying colonic malignancy.
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Low prevalence of Clostridium septicum fecal carriage in an adult population. Anaerobe 2014; 32:34-36. [PMID: 25481351 DOI: 10.1016/j.anaerobe.2014.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 11/10/2014] [Accepted: 12/02/2014] [Indexed: 11/21/2022]
Abstract
Clostridium septicum is an uncommon cause of severe infection. Real-time PCR against the C. septicum-specific alpha-toxin gene (csa) was used to estimate the prevalence of this microbe in human stool from 161 asymptomatic community-dwelling adults and 192 hospitalized patients with diarrhea. All samples were negative, suggesting a low prevalence.
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Ali A, Botha J, Tiruvoipati R. Fatal skin and soft tissue infection of multidrug resistant Acinetobacter baumannii: A case report. Int J Surg Case Rep 2014; 5:532-6. [PMID: 25016080 PMCID: PMC4147652 DOI: 10.1016/j.ijscr.2014.04.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 01/22/2014] [Accepted: 04/17/2014] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Acinetobacter baumannii is usually associated with respiratory tract, urinary tract and bloodstream infections. Recent reports suggest that it is increasingly causing skin and soft tissue infections. It is also evolving as a multidrug resistant organism that can be difficult to treat. We present a fatal case of multidrug resistant A. baumannii soft tissue infection and review of relevant literature. PRESENTATION OF CASE A 41 year old morbidly obese man, with history of alcoholic liver disease presented with left superficial pre-tibial abrasions and cellulitis caused by multidrug resistant (MDR) A. baumannii. In spite of early antibiotic administration he developed extensive myositis and fat necrosis requiring extensive and multiple surgical debridements. He deteriorated despite appropriate antibiotic therapy and multiple surgical interventions with development of multi-organ failure and died. DISCUSSION Managing Acinetobacter infections remains difficult due to the array of resistance and the pathogens ability to develop new and ongoing resistance. The early diagnosis of necrotizing soft tissue infection may be challenging, but the key to successful management of patients with necrotizing soft tissue infection are early recognition and complete surgical debridement. CONCLUSION A. baumannii is emerging as an important cause of severe, life-threatening soft tissue infections. Multidrug resistant A. baumannii soft tissue infections may carry a high mortality in spite of early and aggressive treatment. Clinicians need to consider appropriate early empirical antibiotic coverage or the use of combination therapy to include MDR A. baumannii as a cause of skin and soft tissue infections.
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Affiliation(s)
- Aqsa Ali
- Department of Intensive Care Medicine Frankston Hospital, Frankston, Victoria 3199, Australia.
| | - John Botha
- Department of Intensive Care Medicine Frankston Hospital, Frankston, Victoria 3199, Australia.
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