Touro University henderson nv 89074, NV, United States
Tahne Vongsavath, 1, Rebecca Salvo, DO2 1Touro University, Las Vegas, NV; 2Valley Hospital Medical Center, Las Vegas, NV
Introduction: Clostridium Tertium is an uncommon cause of bacteremia most commonly seen in patients with neutropenic fever and recent abdominal surgery. Non-neutropenic patients generally present with gastrointestinal symptoms. It is a commensal organism that regularly frequents soil, animal and human GI tracts, and oral cavity. It is generally thought to have a low virulence, but has been described more recently to cause severe infection. This case describes an individual with C. Tertium bacteremia likely secondary to a chronic biliary stent.
Case Description/Methods: A 68-year-old male with a history of CVA, diabetes mellitus, and hypertension presented to the ED for positive C. Tertium and E. Coli blood culture drawn 2 days prior. He reported a 3-day history of fevers and weakness in addition to one day of nausea and nonbilious nonbloody emesis. Examination revealed an ill appearing gentleman meeting sepsis criteria, without abdominal pain or hepatomegaly. Lab work was only remarkable for normocytic anemia (Hgb 11.5gm/dL Hct 34.6%). Upon further questioning, the patient reported having an ERCP with biliary stent placement 2 years prior for “stone drainage”, that had never been exchanged, removed, or followed up on. Day 2 cultures grew 1 of 2 vials of C. Tertium and 2 of 2 vials of E. Coli. CT abdomen with contrast showed a large 5.6 X 4.9 cm heterogeneous mass in the posterior lobe of the liver, biliary stent, biliary dilation and common bile duct stones. Empiric intravenous antibiotics were started, and he reported symptom resolution almost immediately. ERCP with sphincterotomy was performed, an occluded common bile duct stent and multiple stones were removed. The liver abscess was drained by CT guidance and grew rare E. Coli. Blood cultures were negative on day 5. The patient remained inpatient to complete his antibiotic course and advised to follow up with hepatology.
Discussion: Clostridium Tertium is a non-toxin producing spore-forming anaerobic bacterium commonly found in the human digestive tract, whose virulence is unknown. It is currently unknown whether it is truly pathogenic or simply a contaminant. In this case, the patient presented without typical neutropenic fever or history of recent invasive abdominal surgeries or immunosuppressants, however, had had prior instrumentation to his biliary tract. Thus, his history suggests the infection was secondary to the prolonged placement of CBD stent.
Disclosures: Tahne Vongsavath indicated no relevant financial relationships. Rebecca Salvo indicated no relevant financial relationships.
Tahne Vongsavath, 1, Rebecca Salvo, DO2. P0836 - Clostridium tertium Liver Abscess: A Case Report on Bacteremia Following Prolonged Common Bile Stent, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.