Fatal Clostridium septicum infection in a patient with non-Hodgkin's lymphoma undergoing multimodal oncologic therapy.
BACKGROUND
Clostridium septicum infections are rare but often fatal. They are known to be associated with a compromised immune system, e.g. with hematologic malignancies.


METHODS
We report on a spontaneous, non-traumatic C. septicum infection in a patient with non-Hodgkin's lymphoma undergoing irradiation due to abdominal bulk. Irradiation was delivered in daily fractions of 1.8 Gy. After 7 fractions, the patient suddenly developed severe pain in the lower leg. Clinical examination showed no pathological findings. However, a rapid progression of symptoms with motoric and sensoric deficits progressed rapidly within hours. Sizzling noise and gas entrainment were detectable about 9 h after the first symptoms. Despite immediate surgical treatment, and in the end amputation, the patient died 14 h later of septic shock. Histopathology showed gas gangrene in the leg tissue, with hemorrhagic muscular necrosis and enclosed gas vesicles. C. septicum was identified as causative organism.


CONCLUSIONS
Irradiation as well as chemotherapy may have enhanced the risk by immunosuppression and induction of mucosal damage. Earlier antibiotic treatment might have slowed down the clinical course and thus given more time for correct diagnosis and treatment.
Krautter
Ute
U
Department of Radiation Oncology, Institute of Hygiene, University of Heidelberg, Germany.
Mory
Martin
M
Mogler
Carolin
C
Schmaus
Martina
M
Zimmermann
Stefan
S
Klemm
Klaus
K
Debus
Jürgen
J
Oertel
Susanne
S
D000368:Aged; D003015:Clostridium Infections / Q000175:diagnosis / Q000209:etiology*; D052557:Clostridium septicum / Q000302:isolation & purification*; D017809:Fatal Outcome; D005738:Gas Gangrene / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D020266:Radiotherapy, Conformal / Q000009:adverse effects*