Pneumorrhachis: an imaging hint of Clostridium septicum infection

Excerpt

An 81-year-old man who had a history of colon cancer presented with fever for 2 days and coma for 3 h. On admission, he displayed septic shock and a multiple organ dysfunction syndrome including disseminated intravascular coagulation (DIC), consciousness disturbance and liver, renal, cardiac and respiratory dysfunction. Blood tests showed that total white blood cell count and procalcitonin was increased to 24.2 × 10⁹/L and 192.16 ng/ml, respectively. Pneumorrhachis along with air in subcutaneous tissues was observed on plain computed tomography (CT) scans (Figs. 1, 2, 3). Blood culture was positive for Clostridium septicum. Despite empirical antibiotics (imipenem and cilastatin sodium, teicoplanin) and intensive organ support, the condition deteriorated rapidly, and he died 36 h after admission because of DIC and massive gastrointestinal haemorrhage. The present case suggests that in patients with risk factors such as colorectal malignancy and immunosuppression presenting with septic shock and pneumorrhachis, clinicians should be alert to the possibility of Clostridium septicum infection before obtaining bacteriologic results, which would help to guide empirical anti-infection treatment.

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