A reminder of the association between Clostridium septicum and colonic adenocarcinoma
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BioMed Central
Open Access
Case report
A reminder of the association between Clostridium septicum and colonic adenocarcinoma Azhar A Khan* and Kim Davenport Address: Department of surgery, Stafford General Hospital, Weston Road, Stafford, ST16 3SA, UK Email: Azhar A Khan* - [email protected]; Kim Davenport - [email protected] * Corresponding author
Published: 28 April 2006 International Seminars in Surgical Oncology2006, 3:12
doi:10.1186/1477-7800-3-12
Received: 20 February 2006 Accepted: 28 April 2006
This article is available from: http://www.issoonline.com/content/3/1/12 © 2006Khan and Davenport; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract We present the case of a patient, with previously unknown liver metastases, presenting with a liver abscess and Clostridium septicum septicaemia. C. septicum is known to be associated with both malignancy and immunosuppression and therefore in patients where this organism is isolated, efforts must be made to exclude an occult underlying malignancy or haematological disorder.
Introduction Severe infection with Clostridium septicum in healthy humans is relatively rare. The organism used to be a well known complication of war wounds in the form of gas gangrene [1]. C. septicum can cause other rigorous focal or disseminated infections by spontaneous invasion from the gut of compromised patients. C. septicum produces exotoxin which is responsible for rapid progression of infection. Exotoxin hydrolyses cell membranes, causes tissue necrosis by inducing occlusive microvascular thrombosis. These spontaneous forms of infection are believed to be associated with colonic malignancy (especially in the cecum) [2], acute leukemia or cyclical neutropenia [3]. Unlike C perfringens, C septicum is aerotolerant and can infect normal tissues. We are reporting this recent case as a reminder of this association and to re-emphasise the importance of investigating these patients for occult malignancy.
Case report A 59 year old gentleman presented with a 3 day history of right upper quadrant pain radiating into the right shoulder. His only past medical history was hypertension. On examination, he was jaundiced with a temperature of
38.2°C, pulse 120 and a blood pressure of 130/80. He was found to have tender hepatomegaly. His blood results showed an anaemia of 9.6, mild renal impairment (urea 11.9, creatinine 142) and hepatic impairment (Bilirubin 60, AST 274, alkaline phosphatase 170). An X-Ray [figure 1] revealed multiple gas filled lesions within the right upper quadrant of the abdomen which were confirmed on ultrasound as originating in the liver. CT [figure 2] revealed the presence of a central core of irregular soft tissue in the liver, which was thought to be an abscess. A drain was inserted under ultrasound guidance. Bot
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