VA Caribbean Healthcare System San Juan, PR, United States
Gian Rodriguez-Franco, MD, Zeyn Mirza, MD, Jaime Martinez-Souss, MD, FACG, José Martin-Ortiz, MD, FACG VA Caribbean Healthcare System, San Juan, Puerto Rico
Introduction: Clostridium septicum bacteremia is a rare, potentially lethal infection associated with colorectal malignancies. Although frequently linked to necrotizing soft tissue infections, this pathogen may present with nonspecific or atypical symptoms and a mortality rate approaching 100% within 48 hours of infection if left untreated. Once discovered, a colonoscopy should be performed to rule out carcinoma. Herein, we report a case of incidental isolation of C. septicum in a patient presenting with fever and tachycardia who later revealed to have an underlying colon adenocarcinoma.
Case Description/Methods: A 70-year-old man was taken to the hospital after developing fever, chills and hypoactivity for one day. He suffered from chronic constipation which worsened for the past month. Vital signs showed high-grade fever 102.4°F, and tachycardia 115bpm. On examination, he had a globose abdomen with adequate bowel sounds and no tenderness. Complete blood count was significant for microcytic, hypochromic anemia with hemoglobin 10.4g/dL and mean corpuscular volume 78. A clinical diagnosis of sepsis secondary to bacteremia was made and the patient was started on Vancomycin and Zosyn empirically. CT scan showed cecum wall thickening concerning for a mass. Final blood cultures revealed C. Septicum and based on sensitivity report Vancomycin was discontinued. Upon questioning, patient denied having prior colonoscopies. Bacteremia with C. septicum heightened the suspicion of colon cancer in this anemic patient with abnormal CT appearance of the cecum. Thus, a colonoscopy was performed and a large mass on the ileocecal valve, proximal to the ascending colon was visualized. Tissue biopsy confirmed colon adenocarcinoma and a right hemicolectomy with ileocolonic anastomosis was done. There was no evidence of regional lymph node involvement and adjuvant therapy was not required. He was discharged home with resolution of symptoms.
Discussion: The growing interest of the gut microbiome research in recent years has established new links between bacteria and large bowel malignancies. The best-known relationship being Streptococcus bovis infection and colon cancer; however, as compared with the latter C. septicum is highly lethal if not treated early. The diverse spectrum of presentation is a diagnostic difficulty which could potentially delay treatment and lead to death. Once diagnosed, there should be a high suspicion of an underlying colon carcinoma and a rigorous search for colorectal carcinoma should be done.
Figure: A: Abdominopelvic CT with Increased irregular cecal wall thickening and adjacent pericecal fat stranding B: Mass lesion occupying 75%-99% of the ileocecal valve circumference and proximal ascending colon C: Ascending mass specimen stained with Diff-Quik revealing rod-shaped organisms compatible with C. Septicum morphology (red arrow)
Gian Rodriguez-Franco indicated no relevant financial relationships.
Zeyn Mirza indicated no relevant financial relationships.
Jaime Martinez-Souss indicated no relevant financial relationships.
José Martin-Ortiz indicated no relevant financial relationships.
Gian Rodriguez-Franco, MD, Zeyn Mirza, MD, Jaime Martinez-Souss, MD, FACG, José Martin-Ortiz, MD, FACG. P2266 - Scope the Cecum in Clostridium Septicum, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.