Clostridium Septicum Aortitis Research Articles

Anterior spinal artery syndrome due to Clostridium septicum aortitis

Anterior spinal artery syndrome due to Clostridium septicum aortitis

CLOSTRIDIAL MYCOTIC ANEURYSM LEADING TO EMPHYSEMATOUS AORTITIS: A CASE REPORT

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Emphysematous aortitis (EA) is a rare consequence of mycotic aneurysm associated with high morbidity and mortality. Most cases have been linked to infection with Staphylococcus species. This case reports clostridial bacteremia leading to arterial myonecrosis and subsequent aortitis. CASE PRESENTATION: The patient was a 66-year-old male with a past medical history of end stage renal disease with an arterio-venous fistula, hypertension, and diabetes who presented with tachycardia, tachypnea, and hypertension for one week. He also had leukocytosis of 23,000/µL with elevated inflammatory markers including a D-dimer of 4700 ng/mL. Computed tomography showed air within the walls of the thoracic aorta and in the periaortic soft tissue with extension from the aortic arch to the mid descending thoracic aorta consistent with aortitis. There was also involvement in the periaortic mediastinal fat and a loculated large left pleural effusion concerning for empyema. Blood cultures revealed Clostridium subterminale, however, gastrointestinal work up did not reveal esophageal or colonic malignancy, or mucosal trauma. He then underwent ascending aorta and distal arch reconstruction. Unfortunately, his post-operative course was complicated by hypotension unresponsive to multiple vasopressors and asystole. Post-mortem aortic tissue cultures were positive for Clostridium innocuum. DISCUSSION: EA is a rare but often fatal sequelae of mycotic aneurysms and has been hypothesized to occur through arterial injury (trauma), bacteremic seeding, contiguous infection, or septic emboli. Risk factors include arterial injury (Intravenous drug use/iatrogenic interventions), infection, immunosuppression, atherosclerosis, and pre-existing aneurysm. Mycotic aneurysms comprise only 0.5% to 1.3% of all aneurysms, and Clostridium species only comprise 0.7% of those cases. C. innocuum aortitis appears to present radiographically similar to other types of Clostridium aortic aneurysms, in which periaortic gas was found to be present in 92.6% of cases. Curiously, the patient was found to have bacteremia with a separate Clostridium species (C. subterminale) from the one found in the aortic wall (C. innocuum). Some reported cases of C. subterminale bacteremia was associated with mucosal damage. The patient’s negative endoscopy findings may suggest a different source of infection for both Clostridium species, possibly via the patient's arterio-venous fistula leading to infection within the atherosclerotic plaques of the aorta. CONCLUSIONS: Emphysematous aortitis is a rare complication of anaerobic infection. A high suspicion should be present in the differential based on radiographic and clinical findings as well as patient risk factors. Reference #1: Sörelius K, Budtz-Lilly J. Systematic Review of the Management of Mycotic Aortic Aneurysms. Eur J Vasc Endovasc Surg. 2019;58(3):426-435. doi:10.1016/j.ejvs.2019.05.004 Reference #2: Ito F, Inokuchi R, Matsumoto A, et al. Presence of periaortic gas in Clostridium septicuminfected aortic aneurysm AIDS in early diagnosis: A case report and systematic review of the literature. J Med Case Rep. 2017;11(1). doi:10.1186/s13256-017-1422-0 Reference #3: Seder CW, Kramer M, Long G, Uzieblo MR, Shanley CJ, Bove P. Clostridium septicum aortitis: Report of two cases and review of the literature. J Vasc Surg. 2009;49(5):1304- 1309. doi:10.1016/j.jvs.2008.11.058 DISCLOSURES: No relevant relationships by Thomas Ng, source=Web Response No relevant relationships by Christopher Pham, source=Web Response

A Case of Clostridium septicum Aortitis With Concomitant Adenocarcinoma of the Cecum

Introduction:Clostridium septicum aortitis (C. septicum aortitis)is an exceedingly rare infection that is strongly associated with underlying adenocarcinoma of the colon. Currently, there are less than 30 cases of C. septicum aortitis that have been reported in the English literature. We report a case of a 73-year-old female with peripheral vascular disease who presented with 4 weeks of severe abdominal pain. Abdominal computed tomography showed, in addition to thickening of the cecal wall, gas in the aortic wall. Colonoscopy performed the following day revealed a large ulcerated mass in the cecum that, under microscopy, was found to be moderately differentiated adenocarcinoma. Around that time, blood cultures began to grow out Clostridium septicum. The patient was offered surgical intervention, but refused; she was treated with antibiotics and discharged home with hospice, dying exactly 1 week later.Figure 1: Computed tomography angiography of the abdomen and pelvis revealing air in the aortic wall.Figure 2: Colonoscopy revealing a large ulcerated cecal mass.

Clostridium septicum Aortitis With Associated Sigmoid Colon Adenocarcinoma

We report an unusual case of Clostridium septicum aortitis with associated adenocarcinoma of the sigmoid colon. An 87-year-old man with multiple medical comorbidities presented with a 1-week history of severe abdominal pain in the left lower quadrant of his abdomen. Abdominal computed tomography showed, in addition to a mass in the sigmoid colon, a gas density within the wall of the abdominal aorta with extensive periaortic fat stranding and some additional gas densities in the proximal left common iliac artery. The patient refused surgery, and was treated with intravenous antibiotics. He died 5 weeks later. The development of Clostridiumsepticum aortitis, an extremely rare but life-threatening infection, is highly associated with an underlying colonic malignancy and demands immediate surgical intervention.

Clostridium septicum aortitis in a patient with extensive atheromatous disease of the aorta

A 69-year man presented with 3days of progressively worsening abdominal pain, radiating to his back, with nausea and vomiting. Computed tomography scan of the abdomen showed evidence of aortitis, for which he eventually underwent surgery. The surgical specimen of the aorta grew Clostridium septicum that was treated with antibiotics.

Clostridium septicumAortitis and Cecal Adenocarcinoma

Clostridium septicum aortitis is a rare infection that is highly associated with underlying malignancy. We present a case of an 82-year-old male diagnosed with both C. septicum aortitis and a high-grade cecal tubulovillous adenoma. The patient was offered aortic resection; however, he opted for only suppressive antibiotic therapy and a right hemicolectomy with ileocolonic anastomosis. He ultimately passed away 75 days following admission. The authors report on the connection between C. septicum aortitis and malignancy. The authors also discuss the need for prompt treatment with antibiotics once the infection is identified and the consideration of aortic resection given the risk of aneurysmal change with aortic dissection or rupture.

Suprarenal Clostridium septicum Aortitis with Rupture and Simultaneous Colon Cancer

We report a case of combined colon cancer and Clostridium septicum aortitis involving the suprarenal abdominal aorta with rupture. An 82-year-old male presented with fever, abdominal pain, and back pain associated with constipation. He was successfully treated by in situ aortic graft placement with polytetrafluroethylene and concomitant colon resection. Only 20 other cases of C. septicum mycotic aneurysm, aortitis, or aortic dissection have been reported. Concomitant surgical treatment for Clostridium aortitis or mycotic abdominal aortic aneurysm and colon cancer can be accomplished successfully in selected cases when the diagnosis of both conditions is made preoperatively.

Primary Clostridium septicum aortitis: A rare cause of necrotizing suprarenal aortic infection : A case report and review of the literature

A 74-year old woman sought medical attention for general symptoms of nausea, vomiting, and back pain. A computed tomographic scan showed gas in the wall of the descending thoracic and suprarenal aortas. Emergency thoracoabdominal exploration revealed a necrotizing infection of the thoracic aorta extending to the origin of the celiac axis. After surgery Clostridium septicum was identified in tissue culture. Surgical management consisted of in-situ graft replacement of the thoracoabdominal aorta. Three months later, a pseudoaneurysm developed at the distal anastomosis. The patient refused further surgery and died 3 days later. The cause of death was presumed to be a ruptured mycotic aneurysm as a result of recurrent C. septicum infection. The relationship of C. septicum with occult gastrointestinal and hematologic malignancy has been documented. This patient represents the 10th reported case of C. septicum arteritis. Including the nine previous case reports of C. septicum arteritis, the mortality rate is 70%. When evaluating a patient with a mycotic aneurysm or aortitis, C. septicum should be considered. If it is found, a search should be carried out for an associated gastrointestinal or hematologic malignancy. Surgical repair should include extraanatomic revascularization and wide debridement of the infected field. Consideration should be given to lifelong antimicrobial therapy for this potentially fatal infection.