Infect Chemother.  2009 Jun;41(3):205-209. 10.3947/ic.2009.41.3.205.

A Case of Aortic Aneurysm Rupture Infected by Clostridium septicum in a Patient with Colon Cancer

• Choi HY
• Park CW
• Noh JY
• Heo JY
• Kim MJ
• Choi WS
• Jo YM
• Song JY
• Kim WJ
• Cheong HJ

• KMID: 1782326
• DOI: http://doi.org/10.3947/ic.2009.41.3.205

Abstract

Infected aortic aneurysm a life-threatening disease entity. Clostridium septicum is a very rare pathogen of infected aneurysms that carries a high mortality rate and demonstrates a strong association with an derlying colonic or hematologic neoplasm. Herein, we report a case of ruptured aortic aneurysm infected by C. septicum in a patient with colon cancer. This is the first reported case of infected aneurysm caused by C. septicum in Korea. Early diagnosis, appropriate antibiotic therapy, and prompt surgical interventions are required considering the rapid downhill progression of C. septicum-induced infected aneurysm.

Keyword

Infected aortic aneurysm; Colon cancer; Clostridium septicum

MeSH Terms

Aneurysm, Infected
Aortic Aneurysm
Aortic Rupture
Clostridium
Clostridium septicum
Colon
Colonic Neoplasms
Early Diagnosis
Hematologic Neoplasms
Humans
Korea
Rupture

Figure

• 

  Figure 1 A) Chest X-ray on admission shows patchy and band-like increased densities in left lung. Pleural effusion is noted in both lower hemithoraces. B) Chest X-ray taken on 5th hospital day shows new opacity in the left para-aortic arch level.

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  Figure 2 A) Abdomen and pelvis CT shows encircling enhancing wall thickening at mid-ascending colon with pericolic fat infiltration and multiple small regional lymph nodes. B) A total colonofiberscopy shows large encircling mass at mid to distal ascending colon, suggestive of colon cancer.

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  Figure 3 A) Chest CT scan shows poorly defined soft tissue densities in superior mediastinum, B) Focal aortic dilation at aortic arch level with numerous intramural air densities is seen.

Reference

1. Fowler VG, Scheld WM, Bayer AS. Mandell GL, Bennett JE, Dolin R, editors. Endocarditis and intravascular infections. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 2005. 6th ed. New York: Churchill Livingstone;975.

2. Lee WK, Mossop PJ, Little AF, Fitt GJ, Vrazas JI, Hoang JK, Hennessy OF. Infected (mycotic) aneurysms: spectrum of imaging appearances and management. Radiographics. 2008. 28:1853–1868.

3. Brown SL, Busuttil RW, Baker JD, Machleder HI, Moore WS, Barker WF. Bacteriologic and surgical determinants of survival in patients with mycotic aneurysms. J Vasc Surg. 1984. 1:541–547.

4. Katlic MR, Derkac WM, Coleman WS. Clostridium septicum infection and malignancy. Ann Surg. 1981. 193:361–364.

5. Kornbluth AA, Danzig JB, Bernstein LH. Clostridium septicum infection and associated malignancy. Report of 2 cases and review of the literature. Medicine (Baltimore). 1989. 68:30–37.

6. Sailors DM, Eidt JF, Gagne PJ, Barnes RW, Barone GW, McFarland DR. Primary Clostridium septicum aortitis: a rare cause of necrotizing suprarenal aortic infection. A case report and review of the literature. J Vasc Surg. 1996. 23:714–718.

7. Drasar BS, Goddard P, Heaton S, Peach S, West B. Clostridia isolated from faeces. J Med Microbiol. 1976. 9:63–71.

8. Moore WE, Holdeman LV. Human fecal flora: the normal flora of 20 Japanese-Hawaiians. Appl Microbiol. 1974. 27:961–979.

9. Holdeman LV, Good IJ, Moore WE. Human fecal flora: variations in bacterial compositions within individuals and a possible effect of emotional stress. Appl Environ Microbiol. 1974. 31:359–375.

10. Leal J, Gregson DB, Ross T, Church DL, Laupland KB. Epidemiology of Clostridium species bacteremia in Calgary, Canada, 2000-2006. J Infect. 2008. 57:198–203.

11. Alpern RJ, Dowell VR Jr. Clostridium septicum infection and malignancy. JAMA. 1969. 209:385–388.

12. Malmgren RA, Flanigan CC. Localization of the vegetative form of Clostridium tetani in mouse tumors following intra venous spore administration. Cancer Res. 1955. 15:473–478.

13. Thiele EH, Arison RN, Boxer GE. Oncolysis by clostridia. IV. Effect of nonpathogcnic clostridial spores in normal and pathological tissues. Cancer Res. 1964. 24:234–238.

14. Jendrzejewski JW, Jones SR, Newcombe RL, Gilbert DN. Nontraumatic clostridial myonecrosis. Am J Med. 1978. 65:542–546.

15. Pelletier JP, Plumbley JA, Rouse EA, Cina SJ. The role of Clostridium septicum in paraneoplastic sepsis. Arch Pathol Lab Med. 2000. 124:353–356.

16. Mohamed HK, Elliott BM, Brothers TE, Robison JG. Suprarena1 Clostridium septicurn aortitis with rupture and simultaneous colon cancer. Ann Vasc Surg. 2006. 20:825–829.

17. Cin CS, Arena GO, Fiture AO, Clase CM, Doobay B. Ruptured mycotic thoracoabdominal aortic aneurysms: a report of three cases and a systematic review. J Vasc Surg. 2001. 33:861–867.

18. Wein M, Bartel T, Kabatnik M, Sadony V, Dirsch O, Erbel R. Rapid progression of bacterial aortitis to an ascending aortic mycotic aneurysm documented by transesophageal echocardiography. J Am Soc Echocardiogr. 2001. 14:646–649.

19. Knosalla C, Weng Y, Yankah AC, Hofmeister J, Hetzer R. Using aortic allograft material to treat mycotic aneurysms of the thoracic aorta. Ann Thorac Surg. 1996. 61:1146–1152.

20. Moneta GL, Taylor LM Jr, Yeager RA, Edwards JM, Nicoloff AD, McConnell DB, Porter JM. Surgical treatment of infected aortic aneurysm. Am J Surg. 1998. 175:396–399.