Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2017

Open Access 01-12-2017 | Case report

Presence of periaortic gas in Clostridium septicum-infected aortic aneurysm aids in early diagnosis: a case report and systematic review of the literature

Authors: Fumihito Ito, Ryota Inokuchi, Akinori Matsumoto, Yoshibumi Kumada, Hideyuki Yokoyama, Tokiya Ishida, Katsuhiko Hashimoto, Masashi Narita, Kazuaki Shinohara

Published in: Journal of Medical Case Reports | Issue 1/2017

Login to get access

Abstract

Background

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.

Case presentation

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.

Conclusions

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.
Literature
1.
Kennedy CL, Krejany EO, Young LF, et al. The α-toxin of Clostridium septicum is essential for virulence. Mol Microbiol. 2005;57:1357–66.CrossRefPubMed
2.
3.
de Virgilio C, Klein S, Chang L, et al. Clostridial bacteremia: implications for the surgeon. Am Surg. 1991;57:388–93.PubMed
4.
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
5.
Jendrzejewski JW, Jones SR, Newcombe RL, et al. Nontraumatic clostridial myonecrosis. Am J Med. 1978;65:542–6.CrossRefPubMed
6.
Seder CW, Kramer M, Long G, et al. Clostridium septicum aortitis: report of two cases and review of literature. J Vasc Surg. 2009;49:1304–9.CrossRefPubMed
7.
Granier M, Granier A, Fraga J, et al. Emphysematous infectious aortitis: a dramatic evolution. Eur Heart J. 2011;32:2085.
8.
Halak M, Heldenberg E, Silverberg D, et al. Clostridium septicum post-endovascular aneurysm repair stent-graft infection. Vascular. 2012;20:104–6.CrossRefPubMed
9.
Colwick SE, Alkhoury F, Martin JT, et al. Abdominal aortic aneurysm repair complicated by infection with Clostridium septicum. Ann Vasc Surg. 2011;25:839. e11–3.CrossRefPubMed
10.
Upchurch Jr GR, Clair DG, Whittemore AD, et al. Clostridium septicum bacteremia associated with aortic graft infection. J Vasc Surg. 1995;22:493–5.CrossRefPubMed
11.
Fisker N, Søgaard P. Early Clostridium septicum endocarditis and myocarditis after reconstruction of congenital heart disease. Clin Microbiol Infect. 1998;4:533–5.CrossRef
12.
13.
14.
Kaufman JL, Fereshetian A, Chang B, et al. Septicemia presenting with endoaneurysmal gas: CT demonstration. AJR Am J Roentgenol. 1988;151:287–8.CrossRefPubMed
15.
16.
Bridges RA, McTamaney JP, Barnes RW. Recognition and management of ruptured infected aneurysm of the abdominal aorta. Vasc Endovasc Surg. 1981;15:360–6.
17.
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
18.
Momont SL, Overholt EL. Aortitis due to metastatic gas gangrene. Wis Med J. 1989;88:28–30.PubMed
19.
Brahan RB, Kahler RC. Clostridium septicum as a cause of pericarditis and mycotic aneurysm. J Clin Microbiol. 1990;28:2377–8.PubMedPubMedCentral
20.
Hurley L, Howe K. Mycotic aortic aneurysm infected by Clostridium septicum—a case history. Angiology. 1991;42:585–9.CrossRefPubMed
21.
Christensen J, Bistrup C. Case report: emphysematous pyelonephritis caused by Clostridium septicum and complicated by a mycotic aneurysm. Br J Radiol. 1993;66:842–3.CrossRefPubMed
22.
Messa 3rd CA, Kulkami M, Arous E. Double clostridial mycotic aneurysms of the aorta. Cardiovasc Surg. 1995;3:687–92.CrossRefPubMed
23.
Murphy DP, Glazier DB, Krause TJ. Mycotic aneurysm of the thoracic aorta caused by Clostridium septicum. Ann Thorac Surg. 1996;62:1835–7.CrossRefPubMed
24.
Sailors DM, Eidt JF, Gagne PJ, et al. Primary Clostridium septicum aortitis: a rare cause of necrotizing suprarenal aortic infection. A case report and review of the literature. J Vasc Surg. 1996;23:714–8.CrossRefPubMed
25.
Monsen T, Palmgren H, Arnerlöv C, et al. Aortic dissection due to Clostridium septicum infection. Eur J Vasc Endovasc Surg. 1997;13:517–8.CrossRefPubMed
26.
Montoya FJ, Weinstein-Moreno LF, Johnson CC. Mycotic thoracic aneurysm due to Clostridium septicum and occult adenocarcinoma of the cecum. Clin Infect Dis. 1997;24:785–1007.CrossRefPubMed
27.
Cohen CA, Almeder LM, Israni A, et al. Clostridium septicum endocarditis complicated by aortic-ring abscess and aortitis. Clin Infect Dis. 1998;26:495–6.CrossRefPubMed
28.
29.
Foga MM, McGinn GJ, Kroeker MA, et al. Sepsis due to Clostridium septicum: case report. Can Assoc Radiol J. 2000;51:85–9.PubMed
30.
Morrison Jr RC, DiMuzio PJ, Kahn M, et al. Clostridial mycotic aneurysm of the thoracoabdominal aorta—a case report. Vasc Surg. 2001;35:303–10.CrossRefPubMed
31.
Al Bahrani BJ, Thomas DJ, Moylan EJ. What’s causing that gas? Med J Aust. 2001;174:652.PubMed
32.
Munshi IA, Rhee SW, Pane T, et al. Clostridium septicum mycotic aortic aneurysm. Am J Surg. 2002;184:54–5.CrossRefPubMed
33.
Zenati MA, Bonanomi G, Kostov D, et al. Images in cardiovascular medicine fulminant clostridium septicum aortitis. Circulation. 2002;105:1871.CrossRefPubMed
34.
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.
35.
Takano H, Taniguchi K, Kuki S, et al. Mycotic aneurysm of the infrarenal abdominal aorta infected by Clostridial septicum: a case report of surgical management and review of the literature. J Vasc Surg. 2003;38:847–51.CrossRefPubMed
36.
Davies M, Byrne J, Harvey JS. Clostridial infection of the abdominal aorta. J Am Coll Surg. 2003;197:331.
37.
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.
38.
39.
Mohamed HK, Elliot BM, Brothers TE, et al. Suprarenal Clostridium septicum aortitis with rupture and simultaneous colon cancer. Ann Vasc Surg. 2006;20:825–9.CrossRefPubMed
40.
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
41.
Laudito A, Gai V, Battista S, et al. Images in cardiovascular medicine. Clostridium septicum arch aortitis. Circulation. 2008;117:1609.CrossRefPubMed
42.
Gai V, Battista S, Bonino L. Electronic clinical challenges and images in GI. Clostridium septicum arch aortitis. Gastroenterology. 2009;136:e4–5.CrossRefPubMed
43.
Yang Z, Reilly SD. Clostridium septicum aortitis causing aortic dissection in a 22-year-old man. Tex Heart Inst J. 2009;36:334–6.PubMedPubMedCentral
44.
45.
46.
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
47.
Annapureddy N, Agarwal SK, Kanakadandi V, et al. Clostridium septicum aortitis in a patient with extensive atheromatous disease of the aorta. J Infect Chemother. 2012;18:948–50.CrossRefPubMed
48.
Ge SP, de Virgilio C. Clostridium septicum aortitis with associated sigmoid colon adenocarcinoma. Ann Vasc Surg. 2012;26:280. el–4.CrossRefPubMed
49.
50.
Tokmaji G, Gosev I, Kumamaru KK, et al. Mycotic aneurysm of the aortic arch presenting with left vocal cord palsy. Ann Thorac Surg. 2013;96:302–5.CrossRefPubMed
51.
Eplinius F, Hädrich C. Acute aortic dissection caused by Clostridium septicum aortitis. Forensic Sci Int. 2014;244:e38–41.CrossRefPubMed
52.
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.
53.
Hashimoto T, Okamatsu Y, Hyakuna Y, et al. Perianeurysmal emphysema: Clostridium septicum-infected aortic aneurysm. Circulation. 2014;129:1900–1.CrossRefPubMed
54.
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.
55.
Shah S, Whitehead D, Sampath K, et al. A case of Clostridium septicum aortitis with concomitant adenocarcinoma of the cecum. ACG Case Rep J. 2015;2:230–2.CrossRefPubMedPubMedCentral
56.
57.
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
58.
Chan FY, Crawford ES, Coselli JS, et al. In situ prosthetic graft replacement for mycotic aneurysm of the aorta. Ann Thorac Surg. 1989;47:193–203.CrossRefPubMed
59.
Müller BT, Wegener OR, Grabitz K, et al. Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extra-anatomic repair in 33 cases. J Vasc Surg. 2001;33:106–13.CrossRefPubMed
60.
Miller DV, Oderich GS, Aubry MC, et al. Surgical pathology of infected aneurysms of the descending thoracic and abdominal aorta: clinicopathologic correlations in 29 cases (1976 to 1999). Hum Pathol. 2004;35:1112–20.CrossRefPubMed
61.
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
62.
Hsu RB, Tsay YG, Wang SS, et al. Surgical treatment for primary infected aneurysm of the descending thoracic aorta, abdominal aorta, and iliac arteries. J Vasc Surg. 2002;36:746–50.CrossRefPubMed
63.
Fichelle JM, Tabet G, Cormier P, et al. Infected infrarenal aortic aneurysms: when is in situ reconstruction safe? J Vasc Surg. 1993;17:635–45.CrossRefPubMed
64.
Ting AC, Cheng SW, Ho P, et al. Surgical treatment of infected aneurysms and pseudoaneurysms of the thoracic and abdominal aorta. Am J Surg. 2005;189:150–4.CrossRefPubMed
65.
Lesèche G, Castier Y, Petit MD, et al. Long-term results of cryopreserved arterial allograft reconstruction in infected prosthetic grafts and mycotic aneurysms of the abdominal aorta. J Vasc Surg. 2001;34:616–22.CrossRefPubMed
66.
Vogt PR, Brunner-La Rocca HP, Carrel T, et al. Cryopreserved arterial allografts in the treatment of major vascular infection: a comparison with conventional surgical techniques. J Thorac Cardiovasc Surg. 1998;116:965–72.CrossRefPubMed
67.
Gupta AK, Bandyk DF, Johnson BL. In situ repair of mycotic abdominal aortic aneurysms with rifampin-bonded gelatin-impregnated Dacron grafts: a preliminary case report. J Vasc Surg. 1996;24:472–6.CrossRefPubMed
68.
Bandyk DF, Novotney ML, Johnson BL, et al. Use of rifampin-soaked gelatin-sealed polyester grafts for in situ treatment of primary aortic and vascular prosthetic infections. J Surg Res. 2001;95:44–9.CrossRefPubMed
69.
Gouny P, Valverde A, Vincent D, et al. Human immunodeficiency virus and infected aneurysm of the abdominal aorta: report of three cases. Ann Vasc Surg. 1992;6:239–43.CrossRefPubMed
70.
71.
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
72.
Sörelius K, Mani K, Björck M, et al. Endovascular treatment of mycotic aortic aneurysms: a European multicenter study. Circulation. 2014;130:2136–42.CrossRefPubMed
73.
Hsu RB, Chen RJ, Wang SS, et al. Infected aortic aneurysms: clinical outcome and risk factor analysis. J Vasc Surg. 2004;40:30–5.CrossRefPubMed
74.
Hollier LH, Money SR, Creely B, et al. Direct replacement of mycotic thoracoabdominal aneurysms. J Vasc Surg. 1993;18:477–84.CrossRefPubMed
Metadata
Title
Presence of periaortic gas in Clostridium septicum-infected aortic aneurysm aids in early diagnosis: a case report and systematic review of the literature
Authors
Fumihito Ito
Ryota Inokuchi
Akinori Matsumoto
Yoshibumi Kumada
Hideyuki Yokoyama
Tokiya Ishida
Katsuhiko Hashimoto
Masashi Narita
Kazuaki Shinohara
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2017
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-017-1422-0

Other articles of this Issue 1/2017

Journal of Medical Case Reports 1/2017 Go to the issue

Case report

Renal damage induced by pemetrexed causing drug discontinuation: a case report and review of the literature

Case report

Isolated unilateral adrenal gland hemorrhage following motor vehicle collision: a case report and review of the literature

Case report

Vitreous amyloidosis with autonomic neuropathy of the digestive tract associated with a novel transthyretin p.Gly87Arg variant in a Bangladeshi patient: a case report

Case report

Internal herniation through lesser omentum hiatus and gastrocolic ligament with malrotation: a case report

Case report

Myoclonic seizure prior to diagnosis of chronic toxic encephalopathy: a case report

Case report

Pediatric tuberculosis-human immunodeficiency virus co-infection in the United Kingdom highlights the need for better therapy monitoring tools: a case report