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.
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.
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.
de Virgilio C, Klein S, Chang L, et al. Clostridial bacteremia: implications for the surgeon. Am Surg. 1991;57:388–93. PubMed
Kornbluth AA, Danzig JB, Bernstein LH. Clostridium septicum infection and associated malignancy. Report of 2 cases and review of the literature. Medicine (Baltimore). 1989;68:30–7. CrossRef
Granier M, Granier A, Fraga J, et al. Emphysematous infectious aortitis: a dramatic evolution. Eur Heart J. 2011;32:2085.
Fisker N, Søgaard P. Early Clostridium septicum endocarditis and myocarditis after reconstruction of congenital heart disease. Clin Microbiol Infect. 1998;4:533–5. CrossRef
El Sayad M, Chikate A, Ramesh B. Gas gangrene presenting with back pain. BMJ Case Rep. 2014. doi: 10.1136/bcr-2013-010241.
Bridges RA, McTamaney JP, Barnes RW. Recognition and management of ruptured infected aneurysm of the abdominal aorta. Vasc Endovasc Surg. 1981;15:360–6.
Semel L, Aikman WO, Parker Jr FB, et al. Nontraumatic clostridial myonecrosis and mycotic aneurysm formation. N Y State J Med. 1984;84:195–6. PubMed
Momont SL, Overholt EL. Aortitis due to metastatic gas gangrene. Wis Med J. 1989;88:28–30. PubMed
Foga MM, McGinn GJ, Kroeker MA, et al. Sepsis due to Clostridium septicum: case report. Can Assoc Radiol J. 2000;51:85–9. PubMed
Al Bahrani BJ, Thomas DJ, Moylan EJ. What’s causing that gas? Med J Aust. 2001;174:652. PubMed
Liechti ME, Schöb O, Kacl GM, et al. Clostridium septicum aortitis in a patient with colon carcinoma. Eur J Clin Microbiol Infect Dis. 2003;22:632–4.
Davies M, Byrne J, Harvey JS. Clostridial infection of the abdominal aorta. J Am Coll Surg. 2003;197:331.
Rucker CM, Menias CO, Bhalla S, et al. Clostridium septicum infrarenal aortitis secondary to occult cecal adenocarcinoma. AJR Am J Roentgenol. 2004;183:1316–8.
Asciutto G, Geier B, Marpe B, et al. A case of contained ruptured aortitis due to Clostridium septicum infection in a patient with a colon malignancy. Chir Ital. 2007;59:743–6. PubMed
Demidovich J, Condoluci M, Fussa M, et al. Photo quiz: a 69-year-old woman with persistent back pain. Clin Infect Dis. 2012;55(254):301–2. CrossRef
Khalid M, Lazarus R, Bowler IC, et al. Clostridium septicum sepsis and its implications. BMJ Case Rep. 2012. doi: 10.1136/bcr-2012-006167.
Al Hadi HI, Patel G, Rees MD. A rare case of Clostridium septicum mycotic aortic arch aneurysm following open right hemicolectomy for colorectal cancer. BMJ Case Rep 2014;2014. doi: 10.1136/bcr-2014-204636.
Lintin L, Wheeler R, Whiston R, et al. Mycotic thoracic aortic arch aneurysm from haematogenous spread of Clostridium septicum due to metastatic colorectal cancer: a survival guide. J Surg Case Rep 2014;2014. doi: 10.1093/jscr/rju117.
Tabasum A, Bleehen R, Healy B, et al. An atypical presentation of colonic malignancy: Clostridium septicum aortitis. BMJ Case Rep. 2015. doi: 10.1136/bcr-2015-209437.
Klontz KC. Frequency of infected aneurysms among patients in department of veterans affairs hospitals, 1986-1990: the role of Salmonella. Mil Med. 1997;162:766–8. PubMed
Cordero Jr JA, Darling 3rd RC, Chang BB, et al. In situ prosthetic graft replacement for mycotic thoracoabdominal aneurysms. Am Surg. 1996;62:35–9. PubMed
Vassileva CM, Aranki S, Brennan JM, et al. Evaluation of the Society of Thoracic Surgeons online risk calculator for assessment of risk in patients presenting for aortic valve replacement after prior coronary artery bypass graft: an analysis using the STS adult cardiac surgery database. Ann Thorac Surg. 2015;100:2109–16. CrossRefPubMed
- Presence of periaortic gas in Clostridium septicum-infected aortic aneurysm aids in early diagnosis: a case report and systematic review of the literature
- BioMed Central