Abstract
BackgroundPrevious reports of infection with Clostridium septicum have identified an unexpected association with concurrent malignancy. The reported rate of associated malignancy has been found to be as high as 81 percent. The purpose of this case report was to present a case of a total knee arthroplasty infected with C. septicum and the subsequent finding of an occult colonic malignancy.Case presentationA 74 year-old man underwent uneventful bilateral total knee arthroplasties. Two weeks post-operatively, he presented with acute swelling, redness and pain of the left knee. Aspiration of the knee was sent for cell count and culture. The cell count demonstrated 39,000 white blood cells per cubic millimeter with 71% of white blood cells identified as neutrophils. Synovial fluid cultures identified the presence of C. septicum, Enterobacter and coagulase negative Staphylococcus. After urgent irrigation and debridement and polyethylene exchange of the affected knee, the patient was placed on intravenous Penicillin G for a period of six weeks. Two weeks into his course of antibiotics, the patient developed hematochezia and was found to have an obstructive colonic malignancy. The patient underwent hemi-colectomy and has since made a complete recovery of both his malignancy and total knee arthroplasty infection.ConclusionRecognition of the association between C. septicum and malignancy is especially important considering the large predicted increase in total joint arthroplasty procedures over the coming decades. In addition to the standard treatment for infection after total joint arthroplasty, identification of Clostridium septicum should initiate a search for associated occult malignancy.
Highlights
Previous reports of infection with Clostridium septicum have identified an unexpected association with concurrent malignancy
In addition to the standard treatment for infection after total joint arthroplasty, identification of Clostridium septicum should initiate a search for associated occult malignancy
We report the case of a 74-year-old man with an acute postoperative infection after total knee arthroplasty (TKA)
Summary
To our knowledge this is the second reported case of a total joint arthroplasty infected by Clostridium septicum. An 85-year-old female presenting with increasing knee pain was diagnosed with septic arthritis Her case was complicated by anemia secondary to melena for which she received multiple transfusions. In addition to the standard treatment for infection after total joint arthroplasty, identification of Clostridium septicum should initiate a search for associated occult malignancy. In this current case report, the malignancy was discovered early enough to provide what appears to be a cure This case underscores the importance of isolating and identifying all organisms and sub-species within a poly-microbial infection, as the isolation of C. septicum will generate the additional concern of an underlying occult malignancy. Received: 27 February 2012 Accepted: 20 September 2012 Published: 2 October 2012
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