Introduction: Clostridium septicum is a rare, aggressive anaerobic bacterium known to cause spontaneous gas gangrene and necrotizing colitis, often in patients with underlying malignancy. While each of these manifestations can occur independently, presentation with multifocal infections is exceedingly rare. We present a case of C. septicum myonecrosis and colitis in a patient without known cancer at the time of presentation.
Description: A 60-year-old female with insulin-dependent diabetes mellitus, hypertension, hyperlipidemia, and remote pulmonary embolism on apixaban presented with several days of nausea, vomiting, bloody diarrhea, abdominal pain. She was febrile, hypotensive, and encephalopathic on arrival. Exam revealed swelling and ecchymosis of the left gluteal region and mild right lower quadrant tenderness. Laboratory studies showed leukocytosis and acute kidney injury. Initial CT imaging demonstrated colonic edema and hyperemia of the cecum and ascending colon, and soft tissue swelling in the left gluteal region without gas or abscess. She was started on intravenous fluids and broad-spectrum antibiotics. Despite resuscitation, her soft tissue infection progressed. On hospital day 1, she underwent emergent surgical debridement of the left buttock for suspected necrotizing soft tissue infection. Despite initial post-op improvement, she continued to be in shock. Repeat CT revealed progression to pancolitis. With ongoing systemic instability, she underwent total abdominal colectomy with end ileostomy on hospital day 4. Blood cultures drawn on admission grew C. septicum on day 5. Pathology revealed a 5.5 cm tubulovillous adenoma with focal high-grade dysplasia at the ileocecal junction, but no invasive carcinoma. Her course was complicated by bilateral pleural effusions, acute kidney injury, and reactive thrombocytosis. She improved with supportive care and was discharged in stable condition.
Discussion: This case illustrates a rare dual presentation of C. septicum myonecrosis and colitis. Though often linked to malignancy, infection may also arise from mucosal injury. In this patient, the absence of invasive carcinoma highlights the potential for significant infection even without neoplasia. Early diagnosis, surgical intervention, and broad spectrum antibiotics are critical to survival.
