Abstract
IntroductionClostridium innocuum is an anaerobic Gram-positive bacterium, unable to produce toxins and rarely causes infections. We report the first case of C. innocuum osteomyelitis and bacteremia in a patient with acute lymphoblastic leukemia (ALL). Findings were compared with previously reported cases of C. innocuum infections in immunocompromised patients, e.g., patients with acquired immune deficiency syndrome, leukemia, and organ transplantation.Case descriptionA 32-year-old Japanese male was admitted for persistent low-grade fever and purpura lasting for 1 month. Complete blood counts and cytogenetic analysis identified Ph1-positive ALL, which was successfully treated using chemotherapy. However, the patient developed high fever and lumbar pain during complete remission. Fluorodeoxyglucose-positron emission tomography and computed tomography demonstrated osteomyelitis. C. innocuum was identified as the causative agent and the patient was successfully treated using antibiotic therapy.Discussion and evaluationWe performed a literature review revealing a number of common aspects to the clinical presentation of C. innocuum infection and an association with various comorbidities. Further, we highlight the most efficient diagnostic and treatment strategies for C. innocuum osteomyelitis.ConclusionsClostridium innocuum can be a causative pathogen of osteomyelitis and bacteremia in immunocompromised patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-1176-3) contains supplementary material, which is available to authorized users.
Highlights
Clostridium innocuum is an anaerobic Gram-positive bacterium, unable to produce toxins and rarely causes infections
Clostridium innocuum can be a causative pathogen of osteomyelitis and bacteremia in immunocompromised patients
We report the first case of pelvic osteomyelitis and sepsis due to C. innocuum infection in a patient with acute lymphocytic leukemia (ALL)
Summary
We identified previously published cases of C. innocuum infection by conducting a PubMed search of the literature using the following keywords: Clostridium innocuum; ALL; osteomyelitis; and anaerobic bacteria. A PubMed search of the literature identified 16 previously reported cases of C. innocuum infection (Smith and King 1962; Castiglioni et al 2003; CrumCianflone 2009; Hung et al 2014; Bodey et al 1991; Cutrona et al.1995). Risk factors for NEC include acute leukemia, lymphoma, solid tumor, and neutropenia in addition to cytotoxic chemotherapeutic agents such as cytosine arabinoside, anthracyclines, and taxanes In this case, the patient complained of abdominal distention and constipation after consolidation chemotherapy was started. Almost all anaerobic osteomyelitis occur by direct extension from an adjacent focus of infection and are rarely due to bacteremia; in the present case, the bacteria may have reached from the intestinal tract to the iliac bone via blood circulation. It is considered that less than 4 weeks of antibiotic therapy is a risk factor for recurrence in patients who have undergone surgical management (Pigrau et al 2015; Lima et al 2014)
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